Individual
DR. JACK LEE SCHRADER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1900 PASEO SAN LUIS, SIERRA VISTA, AZ 85635-4614
(520) 458-2415
(520) 458-0414
Mailing address
1900 PASEO SAN LUIS, SIERRA VISTA, AZ 85635-4614
(520) 458-2415
(520) 458-0414
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AZ2165
AZ
Other
Enumeration date
04/04/2006
Last updated
07/08/2007
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