NPIMap

Organization Active NPI

Casa Grande Oral and Maxillofacial Surgery, P.C.

  • Dental Clinic/Center
  • Casa Grande, AZ
National Provider Identifier
1851569693
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
7170 Issued in AZ
Legal business name
CASA GRANDE ORAL AND MAXILLOFACIAL SURGERY, P.C.
Practice address
1876 E Sabin Dr Ste 6
Casa Grande, AZ 85122-6197
Phone
(520) 876-5227
Fax
(520) 836-2234
NPI assigned
Feb 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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

Authorized official

Name
Dr. Jeremy Wade Cull, DDS
Title
President
Phone
(520) 876-5227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 7170 AZ Primary

Addresses

Primary practice location

1876 E Sabin Dr Ste 6
Casa Grande, AZ 85122-6197

Mailing address

1876 E Sabin Dr Ste 6
Casa Grande, AZ 85122-6197
Phone (520) 876-5227

National Provider Directory

National Provider Directory

Locations

1876 E Sabin Dr
Ste 6
Casa Grande, AZ 85122
Phone (520) 836-2234

NPI Registry JSON

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1851569693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1876 E SABIN DR STE 6",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851226197",
            "telephone_number": "520-876-5227",
            "fax_number": "520-836-2234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1876 E SABIN DR STE 6",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851226197",
            "telephone_number": "520-876-5227",
            "fax_number": "520-836-2234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASA GRANDE ORAL AND MAXILLOFACIAL SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "CULL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "520-876-5227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "7170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Casa Grande, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; 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.