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General NPI Number Information
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NPI Number | 1689396442
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Entity Type | Individual
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Provider Name | JARET SIMONSEN DMD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 3124 STILLWATER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-7151
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Country | US
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Telephone | 928-778-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 3124 STILLWATER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-7151
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Country | US
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Telephone | 928-778-2340
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D012445
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | ETN996
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License Number State | TX
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