Provider Demographics
NPI:1154583995
Name:WHITE, JARED RUSSELL (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:RUSSELL
Last Name:WHITE
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-0236
Mailing Address - Country:US
Mailing Address - Phone:435-257-3210
Mailing Address - Fax:435-257-5436
Practice Address - Street 1:431 W 600 N
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-2411
Practice Address - Country:US
Practice Address - Phone:435-257-3210
Practice Address - Fax:435-257-5436
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7007555-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice