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General NPI Number Information
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NPI Number | 1336580414
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Entity Type | Individual
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Provider Name | JARED ALAN FUNT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 100 BELLEMEADE RD SUITE B
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City | SETAUKET
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State | NY
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Zip | 11733-3530
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Country | US
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Telephone | 631-675-1694
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BELLEMEADE RD SUITE B
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City | SETAUKET
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State | NY
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Zip | 11733-3530
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Country | US
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Telephone | 631-675-1694
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 055786-1
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License Number State | NY
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