Individual
JARREL LEELAND TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
221 CROWE AVE, MARS, PA 16046-0409
(724) 625-2530
(724) 625-2590
Mailing address
PO BOX 409, 221 CROWE AVE, MARS, PA 16046-0409
(724) 625-2530
(724) 625-2590
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS0269009L
PA
Other
Enumeration date
04/12/2007
Last updated
07/08/2007
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