Provider Demographics
NPI:1124281092
Name:ANDERSON, JARED R (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:R
Last Name:ANDERSON
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 1:1800 VALLEY RIVER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6714
Mailing Address - Country:US
Mailing Address - Phone:541-301-8861
Mailing Address - Fax:
Practice Address - Street 1:325 A STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-488-5088
Practice Address - Fax:541-488-5199
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD80861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice