Provider Demographics
NPI:1962799387
Name:KEARSCHNER, JARED J (DDS)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:J
Last Name:KEARSCHNER
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 1:5855 MADISON AVE STE H
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-4630
Mailing Address - Country:US
Mailing Address - Phone:317-787-6160
Mailing Address - Fax:317-787-2333
Practice Address - Street 1:5855 MADISON AVE STE H
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-4630
Practice Address - Country:US
Practice Address - Phone:317-787-6160
Practice Address - Fax:317-787-2333
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011704A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist