Jourdyn Allyson Buckheit, DMD
Individual provider Active NPI Dentist · Coolidge, AZ
NPI 1861236366 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1861236366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D012219 (AZ)
- Practice address
- 1501 N Arizona Blvd
Coolidge, AZ 85128-3215 - Phone
- (520) 723-1700
- NPI assigned
- Jun 20, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| D012219 | AZ | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D012219 | AZ | Yes |
Addresses
Primary practice location
1501 N Arizona Blvd
Coolidge, AZ 85128-3215
Mailing address
7549 W Villa Theresa Dr
Glendale, AZ 85308-8258
Phone (570) 404-6350
Other providers in Coolidge, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. 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.