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General NPI Number Information
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NPI Number | 1992134803
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Entity Type | Individual
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Provider Name | JAROM STRADLING
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Gender | Male
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 1300 N MCCLINTOCK DR
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City | CHANDLER
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State | AZ
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Zip | 85226-7205
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Country | US
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Telephone | 480-818-4890
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Fax |
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Provider Business Mailing Address
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Address Line | 20186 E CAMINA BUENA VIS
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5114
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D008848
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 29557
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License Number State | TX
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