Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | LL-443-17 | NV |
NPI | 1073036711 |
---|---|
Provider Name | Dr. Dan Jarrett |
First Address | Las Vegas, NV 89148-5163 |
Second Address | Las Vegas, NV 89106-4124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 25/07/2017 |