MEDICARE: JARED REESE FOUTZ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DB-2025-0149	NM

General Provider Information

NPI Number	:	1558244970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED REESE FOUTZ DMD

Provider Business Mailing Address
First Line	:	3255 BURNHAM RD
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-7933
Country	:	US
Telephone Number	:	505-419-7783
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 E PINON FRONTAGE RD BLDG 300
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-5084
Country	:	US
Telephone Number	:	505-327-3331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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