Healthcare Provider Details

I. General information

NPI: 1982959375
Provider Name (Legal Business Name): JEREMIAH W STURGILL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2012
Last Update Date: 07/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 E STILL CIR
MESA AZ
85206-3631
US

IV. Provider business mailing address

898 S HENRY LN
GILBERT AZ
85296-1474
US

V. Phone/Fax

Practice location:
  • Phone: 276-275-3296
  • Fax:
Mailing address:
  • Phone: 276-275-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008503
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: