Jeffery Dean Andersen, D.D.S
Individual provider Active NPI General Practice Dentistry · Overgaard, AZ
NPI 1851481733 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1851481733
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D6578 (AZ)
- Practice address
- 3367 Buckskin Rd.
Overgaard, AZ 85933-0100 - Phone
- (928) 535-5886
- Fax
- (928) 535-5887
- NPI assigned
- Oct 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D6578 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mogollon Family Dentistry | General Practice | Past | Accepting new patients |
| Mogollon Family Dentistry | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D6578 | AZ | Yes |
Addresses
Primary practice location
3367 Buckskin Rd.
Overgaard, AZ 85933-0100
Mailing address
PO Box 100
Overgaard, AZ 85933-0100
Phone (928) 535-5886
Other providers in Overgaard, AZ
- Aaron C Bornstein
- Nathan M Brooks
- Changepoint Integrated Health
- Compass Medical Center Heber, PLLC
- Compassion Services Inc
All providers in Overgaard, AZ · General Practice Dentistry in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.