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General NPI Number Information
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NPI Number | 1255124426
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Entity Type | Individual
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Provider Name | JARED TIMOTHY HARRISON DDS
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Gender | Male
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 9420 WATSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1529
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Country | US
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Telephone | 314-843-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 13021 E 21ST AVE APT C533
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City | AURORA
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State | CO
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Zip | 80045-7454
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Country | US
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Telephone | 970-433-6454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2025018247
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License Number State | MO
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