Provider Demographics
NPI:1447535554
Name:JOHN JARED WAITE, DDS, PC
Entity type:Organization
Organization Name:JOHN JARED WAITE, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-282-3400
Mailing Address - Street 1:6260 WOODMEN PARK VW STE 150
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2621
Mailing Address - Country:US
Mailing Address - Phone:719-282-3400
Mailing Address - Fax:719-282-3401
Practice Address - Street 1:6260 WOODMEN PARK VW STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2621
Practice Address - Country:US
Practice Address - Phone:719-282-3400
Practice Address - Fax:719-282-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8854122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty