Provider Demographics
NPI:1326817396
Name:HAURET, JEREMY LEE (DMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LEE
Last Name:HAURET
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20210 HYATT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-9448
Mailing Address - Country:US
Mailing Address - Phone:208-240-1123
Mailing Address - Fax:
Practice Address - Street 1:316 SAINT ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3363
Practice Address - Country:US
Practice Address - Phone:573-336-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025002970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist