Provider Demographics
NPI:1578734182
Name:JERNBERG, ANNE FITZGERALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:FITZGERALD
Last Name:JERNBERG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6535 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:UNIT 147
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4377
Mailing Address - Country:US
Mailing Address - Phone:480-924-1241
Mailing Address - Fax:
Practice Address - Street 1:2375 E CAMELBACK RD
Practice Address - Street 2:SUITE 500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3424
Practice Address - Country:US
Practice Address - Phone:602-488-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD 7394122300000X
NMDD2958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist