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General NPI Number Information
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NPI Number | 1336646520
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Entity Type | Individual
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Provider Name | JARED URE DMD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 102 ALABAMA ST STE A
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City | CRESTVIEW
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State | FL
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Zip | 32536-2518
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Country | US
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Telephone | 850-682-4516
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Fax |
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Provider Business Mailing Address
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Address Line | 102 ALABAMA ST STE A
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City | CRESTVIEW
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State | FL
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Zip | 32536-2518
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Country | US
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Telephone | 850-682-4516
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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 | 26600
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License Number State | FL
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