Healthcare Provider Details

I. General information

NPI: 1205894490
Provider Name (Legal Business Name): JEROME A SCHWEIKERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W BELL RD SUITE #9
PHOENIX AZ
85053-2750
US

IV. Provider business mailing address

4025 W BELL RD SUITE #9
PHOENIX AZ
85053-2750
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-2890
  • Fax:
Mailing address:
  • Phone: 602-978-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberAZ 1572
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: