Provider Demographics
NPI:1952498263
Name:SUAVERDEZ, JAY S (DDS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:S
Last Name:SUAVERDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SESINANDO
Other - Middle Name:P
Other - Last Name:SUAVERDEZ
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14441 W. MCDOWELL RD
Mailing Address - Street 2:B106
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395
Mailing Address - Country:US
Mailing Address - Phone:623-536-3264
Mailing Address - Fax:
Practice Address - Street 1:1631 N. 144TH AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395
Practice Address - Country:US
Practice Address - Phone:602-505-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice