Jared Benjamin Tinker, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D010531 Issued in AZ

Practice address

3592 S Atherton Blvd Ste 107
Gilbert, AZ 85297-7444

Phone

(401) 456-4038

NPI assigned

Mar 22, 2018

Reactivated

Apr 5, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593820800000",
    "number": "1487158473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3442 E TULSA ST",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852953453",
            "telephone_number": "602-885-9864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3592 S ATHERTON BLVD STE 107",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852977444",
            "telephone_number": "401-456-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TINKER",
        "first_name": "JARED",
        "middle_name": "BENJAMIN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-22",
        "last_updated": "2020-07-04",
        "certification_date": "2020-07-04",
        "deactivation_date": "2018-03-25",
        "reactivation_date": "2018-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D010531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dentistry in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2020; 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.