Healthcare Provider Details

I. General information

NPI: 1366741142
Provider Name (Legal Business Name): BRETT L SPERRY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13925 W. MEEKER BLVD SUITE 1A
SUN CITY WEST AZ
85375
US

IV. Provider business mailing address

13925 W. MEEKER BLVD SUITE 1A
SUN CITY WEST AZ
85375
US

V. Phone/Fax

Practice location:
  • Phone: 623-854-0733
  • Fax: 623-524-1799
Mailing address:
  • Phone: 623-854-0733
  • Fax: 623-524-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009907
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: