Provider Demographics
NPI:1124164785
Name:JARRETT, ROBERT MARION (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARION
Last Name:JARRETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 HAUTE LOIRE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2964
Mailing Address - Country:US
Mailing Address - Phone:636-394-4642
Mailing Address - Fax:
Practice Address - Street 1:111 S MERAMEC AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1711
Practice Address - Country:US
Practice Address - Phone:314-615-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0110451223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health