Healthcare Provider Details

I. General information

NPI: 1033950019
Provider Name (Legal Business Name): MR. DYLAN JOSEPH HJERPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 200
PHOENIX AZ
85050-4269
US

IV. Provider business mailing address

13521 W BANFF LN
SURPRISE AZ
85379-8315
US

V. Phone/Fax

Practice location:
  • Phone: 480-284-8087
  • Fax:
Mailing address:
  • Phone: 623-980-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: