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General NPI Number Information
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NPI Number | 1548452907
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Entity Type | Organization
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Legal Business Name | JAY S. SUAVERDEZ DDS PLLC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 14441 W. MCDOWELL RD SUITE B106
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City | GOODYEAR
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State | AZ
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Zip | 85395
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Country | US
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Telephone | 623-536-3264
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Fax |
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Provider Business Mailing Address
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Address Line | 14441 W. MCDOWELL RD SUITE B106
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City | GOODYEAR
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State | AZ
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Zip | 85395
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Country | US
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Telephone | 623-536-3264
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Fax |
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Authorized Official
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Title or Position | DDS/MANAGING MEMBER
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Name | JAY S. SUAVERDEZ
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Credential | DDS
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Telephone | 602-505-9243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D5831
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License Number State | AZ
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