Jeffrey C. Derickson, D.D.S. PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2369 Issued in AZ

Legal business name

JEFFREY C. DERICKSON, D.D.S. PLLC

Practice address

762 N Country Club Rd
Tucson, AZ 85716-4535

Phone

(520) 327-5993

Fax

(520) 327-0907

NPI assigned

Jul 3, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey Cline Derickson, D.D.S.

Title

Owner

Phone

(520) 327-5993

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343260800000",
    "number": "1154529006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "762 N COUNTRY CLUB RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857164535",
            "telephone_number": "520-327-5993",
            "fax_number": "520-327-0907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "762 N COUNTRY CLUB RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857164535",
            "telephone_number": "520-327-5993",
            "fax_number": "520-327-0907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY C. DERICKSON, D.D.S. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-03",
        "last_updated": "2012-07-26",
        "status": "A",
        "authorized_official_last_name": "DERICKSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "CLINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-327-5993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "2369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff D Wiese LCSW PLLC
• Leo Daniel Jeffero Jr., MC, LMFT
• Eric Keith Jeffers, ED.S.
• Kristy Jefferson, LPN
• Jeffrey B Loomer, MD, PC
• Jeffrey H Dubois DDS PC
• Jeffrey M. Nelson, M.D., P.C.
• Jeffrey Monash, M.D.P.C.
• Brigid Jeffrey, RN
• Emily Ann Jeffrey, M.D.

• Dental Clinic/Center in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Dental Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.