Jeremy Kyle Hargrove, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D010003 Issued in AZ

Practice address

2051 Evergreen LN Ste a
Show Low, AZ 85901-7928

Phone

(928) 457-1200

Fax

(928) 457-1199

NPI assigned

May 18, 2018

Last updated

Nov 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• White Mountain Endodontics PLLC

  • Endodontics
  • Show Low, AZ
  • NPI 1255051223
  Authorized official Same address or phone
• Jenna Park DMD PLC

  • General Practice Dentistry
  • Tucson, AZ
  • NPI 1174414320
  NPD (past)
• Sinhui Lee DDS PLC

  dba Aspen Dental

  • Dentist
  • Tucson, AZ
  • NPI 1457714289
  NPD (past)

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

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667692800000",
    "number": "1891285425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 EVERGREEN LN STE A",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017928",
            "telephone_number": "928-457-1200",
            "fax_number": "928-457-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 EVERGREEN LN STE A",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017928",
            "telephone_number": "928-457-1200",
            "fax_number": "928-457-1199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6303 E Broadway Blvd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857103547",
            "country_code": "US",
            "telephone_number": "520-276-1654",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4356 N Oracle Rd Ste 140",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857051634",
            "country_code": "US",
            "telephone_number": "520-888-1044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1218 W Irvington Rd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857141136",
            "country_code": "US",
            "telephone_number": "520-330-3307",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 S White Mountain Rd",
            "address_purpose": "LOCATION",
            "city": "Show Low",
            "state": "AZ",
            "postal_code": "859016112",
            "country_code": "US",
            "telephone_number": "928-457-1200",
            "fax_number": "928-457-1199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARGROVE",
        "first_name": "JEREMY",
        "middle_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-18",
        "last_updated": "2022-11-06",
        "certification_date": "2022-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "AZ",
            "license": "D010003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Hansen, FNP
• Mason Swede Hansen
• Jaskiranjit Hanson, FNP-BC
• Kathleen Hanson, MA
• Nicole Ann Hanson
• Payton Harker
• Estelle Theresa Harrison, LPC
• Sara Hart, LCSW
• Haven of Show Low Alf LLC (Haven of Show Low ALF)
• Haven of Show Low, LLC

• Endodontics in Show Low, AZ
• Providers in Show Low, AZ by specialty
• Endodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.