Individual
DR. DERICK JACK SOVEREIGN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3765 E BLUE LUPINE DR STE A, WASILLA, AK 99654-8417
(480) 341-0791
Mailing address
3765 E BLUE LUPINE DR STE A, WASILLA, AK 99654-8417
(480) 341-0791
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
224623
AK
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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