Organization
CASA GRANDE ORAL AND MAXILLOFACIAL SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY WADE CULL DDS (PRESIDENT)
(520) 876-5227
Entity
Organization
Contact information
Practice address
1876 E SABIN DR STE 6, CASA GRANDE, AZ 85122-6197
(520) 876-5227
(520) 836-2234
Mailing address
1876 E SABIN DR STE 6, CASA GRANDE, AZ 85122-6197
(520) 876-5227
(520) 836-2234
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7170
AZ
Other
Enumeration date
02/14/2008
Last updated
01/28/2015
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