Provider Demographics
NPI:1346688520
Name:CURTIS, JARED GLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:GLEN
Last Name:CURTIS
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 1:4775 W DAYBREAK PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5138
Mailing Address - Country:US
Mailing Address - Phone:801-280-1911
Mailing Address - Fax:801-255-2394
Practice Address - Street 1:4775 W DAYBREAK PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5138
Practice Address - Country:US
Practice Address - Phone:801-280-1911
Practice Address - Fax:801-255-2394
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 603846411223G0001X
IDD45401223G0001X
UT9094625-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice