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General NPI Number Information
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NPI Number | 1528264280
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Entity Type | Individual
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Provider Name | JARED ACOSTA DMD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7701 E BROADWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85710-3941
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Country | US
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Telephone | 520-722-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 12112 N RANCHO VISTOSO BLVD # 150-305
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City | ORO VALLEY
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State | AZ
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Zip | 85755-1840
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 7271
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License Number State | AZ
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