Provider Demographics
NPI:1508086034
Name:SEDONA ENDODONTICS, LTD
Entity Type:Organization
Organization Name:SEDONA ENDODONTICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HREHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:928-204-9213
Mailing Address - Street 1:1120 W HIGHWAY 89A STE B4
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5767
Mailing Address - Country:US
Mailing Address - Phone:928-204-9213
Mailing Address - Fax:928-204-9215
Practice Address - Street 1:1120 W HIGHWAY 89A STE B4
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5767
Practice Address - Country:US
Practice Address - Phone:928-204-9213
Practice Address - Fax:928-204-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD43011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty