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General NPI Number Information
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NPI Number | 1306031539
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Entity Type | Individual
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Provider Name | N. JARED DASTRUP D.D.S
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Gender | Male
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 5725 ERINDALE DR STE 106
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918
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Country | US
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Telephone | 719-596-9220
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Fax | 719-574-4567
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Provider Business Mailing Address
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Address Line | 5725 ERINDALE DR STE 106
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1984
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Country | US
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Telephone | 719-596-9220
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Fax | 719-574-4567
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10185
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5341183-9922
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License Number State | UT
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