MEDICARE: DR. JARED GARETH DANIELSON DDS

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	1223P0221X	Pediatric Dentistry	52846	CA

General Provider Information

NPI Number	:	1609903541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED GARETH DANIELSON DDS

Provider Business Mailing Address
First Line	:	4517 SERRANO PKWY STE 102
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7569
Country	:	US
Telephone Number	:	916-573-3387
Fax Number	:	916-919-8521

Provider Business Practice Location Address
First Line	:	4517 SERRANO PKWY STE 102
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-7569
Country	:	US
Telephone Number	:	916-573-3387
Fax Number	:	916-919-8521

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	04/06/2022

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