Jared Wayne Mack, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

11959048 Issued in UT

Practice address

624 S 1000 E Ste 17
St George, UT 84790-5898

Phone

(435) 289-6600

Fax

(435) 289-6900

NPI assigned

Aug 18, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. George Red Rocks PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • St George, UT
  • NPI 1356084107
  NPD
• Cedar City Red Rocks PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Cedar City, UT
  • NPI 1497498158
  NPD (past)
• Arshiya Sharafi, DDS, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • San Diego, CA
  • NPI 1548637002
  NPD (past)
• Marilyn Kaufhold, M.D., a Medical Corporation

  • Children's Hospital
  • San Diego, CA
  • NPI 1336359389
  NPD (past)
• Yuma Regional Medical Center

  • General Acute Care Hospital
  • Yuma, AZ
  • NPI 1194706655
  NPD (past)
• Yuma Sonoma Oral Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Yuma, AZ
  • NPI 1356096606
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673827200000",
    "number": "1306092663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 S 1000 E STE 107",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847905902",
            "telephone_number": "435-289-6600",
            "fax_number": "435-289-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 S 1000 E STE 17",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847905898",
            "telephone_number": "435-289-6600",
            "fax_number": "435-289-6900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4125 Sorrento Valley Blvd",
            "address_2": "Suite D",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92121",
            "country_code": "US",
            "telephone_number": "858-997-2701",
            "fax_number": "858-550-5954",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "66 W Harding Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Cedar City",
            "state": "UT",
            "postal_code": "847202596",
            "country_code": "US",
            "telephone_number": "435-289-6600",
            "fax_number": "435-289-6900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1325 W 16th St",
            "address_purpose": "LOCATION",
            "city": "Yuma",
            "state": "AZ",
            "postal_code": "853644496",
            "country_code": "US",
            "telephone_number": "928-329-6447",
            "fax_number": "928-782-8036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "JARED",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-18",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "57690",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "57690",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "UT",
            "license": "11959048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cary Mac Arthur, LMFT
• Gary Patrick Macdonald, D.O.
• Rhonda Sikes Macfadzen, LMT
• Michelle Macfarlane, MPA-C
• Carlos Agustin Maciel
• Matthew Mackay, PSY.D.
• Vanessa Macneill, CPSS
• Made for More Therapy Co LLC
• Angela Madeux, CSW
• Tania Lynn Madrigal

• Oral and Maxillofacial Surgery (Dentist) in St George, UT
• Providers in St George, UT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.