Provider Demographics
NPI:1104021476
Name:CULL, JEREMY WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WADE
Last Name:CULL
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1876 E SABIN DR
Mailing Address - Street 2:STE 6
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6197
Mailing Address - Country:US
Mailing Address - Phone:520-876-5227
Mailing Address - Fax:520-423-3013
Practice Address - Street 1:1876 E SABIN DRIVE SUITE #18
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-876-5227
Practice Address - Fax:520-876-4059
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2019-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ71701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery