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General NPI Number Information
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NPI Number | 1972908051
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Entity Type | Organization
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Legal Business Name | JARED G. DANIELSON, DDS, DENTAL CORPORATION
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 8689 FOLSOM BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95826-3708
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Country | US
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Telephone | 916-230-8837
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Fax |
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Provider Business Mailing Address
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Address Line | 3628 WALKER PARK DR
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-7609
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Country | US
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Telephone | 916-230-8837
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JARED G DANIELSON
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Credential | DDS
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Telephone | 916-230-8837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 52846
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License Number State | CA
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