1770334096 NPI number — DR. JARED KIRBY FAUSNAUGHT DMD

Table of content: DR. JARED KIRBY FAUSNAUGHT DMD (NPI 1770334096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770334096 NPI number — DR. JARED KIRBY FAUSNAUGHT DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAUSNAUGHT
Provider First Name:
JARED
Provider Middle Name:
KIRBY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770334096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1496 W STONE GATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA SPRINGS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84045-5358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-717-6505
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10894 S RIVER FRONT PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84095-5609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-878-1251
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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