Jared Michael Southwell, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2025023621 Issued in MO

Practice address

2901 St. John'S Blvd
Joplin, MO 64804-1598

Phone

(417) 208-0630

NPI assigned

Oct 24, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Summit Family Dental of Kirtland, LLC

  • General Practice Dentistry
  • Kirtland, NM
  • NPI 1710215439
  NPD (past)

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

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1689950503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 SAINT JOHNS BLVD",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041598",
            "telephone_number": "417-208-0630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 ST. JOHN'S BLVD",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041598",
            "telephone_number": "417-208-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHWELL",
        "first_name": "JARED",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-24",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3690",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2025023621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Joseph Sosa
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• Ashley Southern-Devoe, NP
• Tracy Southern, APRN
• Southwest Foot Clinic, LLC
• Southwest Gastroenterology, LLC
• Southwest Hearing and Balance
• Southwest Missouri Foot Clinics, Inc.
• Southwest Mo Foot Clinics

• Dentist in Joplin, MO
• Providers in Joplin, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; 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.