Basic Information
Provider Information
NPI: 1427064773
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JARET
FirstName: ALEC
MiddleName: H.
NamePrefix: DR.
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 888 WORCESTER ST
Address2: SUITE 130
City: WELLESLEY
State: MA
PostalCode: 024823744
CountryCode: US
TelephoneNumber: 6179646681
FaxNumber: 3396862561
Practice Location
Address1: 888 WORCESTER ST
Address2: SUITE 130
City: WELLESLEY
State: MA
PostalCode: 024823744
CountryCode: US
TelephoneNumber: 6179646681
FaxNumber: 3396862561
Other Information
ProviderEnumerationDate: 07/31/2006
LastUpdateDate: 08/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X15142MAY Dental ProvidersDentist 
122300000XDS029317LPAN Dental ProvidersDentist 
122300000X22D101941400NJN Dental ProvidersDentist 
122300000X0022019TXN Dental ProvidersDentist 
122300000X4823-015WIN Dental ProvidersDentist 

ID Information
IDTypeStateIssuerDescription
026520905MA MEDICAID
17055760105TX MEDICAID
001523393000405PA MEDICAID
3373550005WI MEDICAID


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