Healthcare Provider Details

I. General information

NPI: 1952498263
Provider Name (Legal Business Name): JAY S. SUAVERDEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SESINANDO P. SUAVERDEZ II DDS

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14441 W MCDOWELL RD STE B106
GOODYEAR AZ
85395-2519
US

IV. Provider business mailing address

14441 W MCDOWELL RD STE B106
GOODYEAR AZ
85395-2519
US

V. Phone/Fax

Practice location:
  • Phone: 602-505-9243
  • Fax:
Mailing address:
  • Phone: 623-536-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberD5831
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5831
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5831
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: