Jared Moberg, D.D.S.
Individual provider Active NPI Dentist · Jacksonville, CA
NPI 1487055950 · NPPES record last updated Sep 15, 2014
Key facts
- NPI
- 1487055950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901021195 (MI)
- Practice address
- 2005 Knight Lane Building H
Navy Medicine Support Command Attention Medical Staff
Jacksonville, CA 32212-0140 - Phone
- (760) 725-3213
- NPI assigned
- Sep 15, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901021195 | MI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901021195 | MI | Yes |
Addresses
Primary practice location
2005 Knight Lane Building H
Navy Medicine Support Command Attention Medical Staff
Jacksonville, CA 32212-0140
Mailing address
13128 14TH Street
Camp Pendleton, CA 92058
Phone (651) 343-7779
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.