=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780804294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFERY P HREHA DDS, MSD.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 W HIGHWAY 89A STE B4
-----------------------------------------------------
City | SEDONA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86336-5767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-204-9213
-----------------------------------------------------
Fax | 928-204-9215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1120 W HIGHWAY 89A STE B4
-----------------------------------------------------
City | SEDONA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86336-5767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-204-9213
-----------------------------------------------------
Fax | 928-204-9215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | D4301
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------