Individual
DR. JEFFREY STANDAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
104 MEDICINE WAY, PERIDOT, AZ 85542-0000
(928) 475-1480
Mailing address
104 MEDICINE WAY, PERIDOT, AZ 85542-0000
(928) 475-1480
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009457
AZ
Other
Enumeration date
07/01/2016
Last updated
10/21/2016
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