| Casa Grande Oral And Maxillofacial Surgery, P.c. | |
|
1876 E Sabin Dr Ste 6 Casa Grande AZ 85122-6197 | |
| (520) 876-5227 | |
| (520) 836-2234 |
| Full Name | Casa Grande Oral And Maxillofacial Surgery, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1876 E Sabin Dr Ste 6, Casa Grande, Arizona |
| Authorized Official Name and Position | Jeremy Wade Cull (PRESIDENT) |
| Authorized Official Contact | 5208765227 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Casa Grande Oral And Maxillofacial Surgery, P.c. 1876 E Sabin Dr Ste 6 Casa Grande AZ 85122-6197 Ph: (520) 876-5227 | Casa Grande Oral And Maxillofacial Surgery, P.c. 1876 E Sabin Dr Ste 6 Casa Grande AZ 85122-6197 Ph: (520) 876-5227 |
| NPI Number | 1851569693 |
|---|---|
| Provider Enumeration Date | 02/14/2008 |
| Last Update Date | 01/28/2015 |
| Medicare PECOS PAC ID | 2163506106 |
|---|---|
| Medicare Enrollment ID | O20080228000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851569693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 7170 (Arizona) | Primary |
| Provider Name | Jeremy W Cull |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1104021476 PECOS PAC ID: 3779667225 Enrollment ID: I20080222000349 |
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