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General NPI Number Information
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NPI Number | 1265999494
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Entity Type | Organization
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Legal Business Name | SAGEBRUSH DENTAL LLC
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Dates
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Enumeration Date | 02/24/2019
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 1114 N MISSION ST STE C
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City | WENATCHEE
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State | WA
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Zip | 98801-6711
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Country | US
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Telephone | 509-436-8202
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 PITCHER CANYON RD
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City | WENATCHEE
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State | WA
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Zip | 98801-9448
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Country | US
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Telephone | 360-620-7266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERICH JURGES
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Credential | DDS
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Telephone | 509-436-8202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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