MEDICARE: JARED MAUGHAN WEAVER 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	122300000X	Dentist	7022422-9922	UT

General Provider Information

NPI Number	:	1851555650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED MAUGHAN WEAVER DDS

Provider Business Mailing Address
First Line	:	2011 S 1300 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84105-3613
Country	:	US
Telephone Number	:	801-484-0792
Fax Number	:	801-953-0638

Provider Business Practice Location Address
First Line	:	2011 S 1300 E
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84105-3613
Country	:	US
Telephone Number	:	801-484-0792
Fax Number	:	801-953-0638

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

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	07/21/2022

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Directions to “ JARED MAUGHAN WEAVER DDS” Practice Location

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