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General NPI Number Information
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NPI Number | 1952830945
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Entity Type | Individual
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Provider Name | JARED SEXAUER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 455 N 3RD E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2738
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Country | US
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Telephone | 208-587-2625
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Fax |
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Provider Business Mailing Address
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Address Line | 685 N 4TH E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2134
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-4840
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License Number State | ID
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