Provider Demographics
NPI:1386321784
Name:FERRIN, JEREMIAH (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:
Last Name:FERRIN
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 1:793 E WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7564
Mailing Address - Country:US
Mailing Address - Phone:801-849-1045
Mailing Address - Fax:801-304-3151
Practice Address - Street 1:793 E WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7564
Practice Address - Country:US
Practice Address - Phone:801-849-1045
Practice Address - Fax:801-304-3151
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT134594231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice