Provider Demographics
NPI:1487158473
Name:TINKER, JARED BENJAMIN (DMD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:BENJAMIN
Last Name:TINKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 E TULSA ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3453
Mailing Address - Country:US
Mailing Address - Phone:602-885-9864
Mailing Address - Fax:
Practice Address - Street 1:3592 S ATHERTON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7444
Practice Address - Country:US
Practice Address - Phone:401-456-4038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2020-07-04
Deactivation Date:2018-03-25
Deactivation Code:
Reactivation Date:2018-04-05
Provider Licenses
StateLicense IDTaxonomies
AZD0105311223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program