Provider Demographics
NPI:1265999494
Name:SAGEBRUSH DENTAL LLC
Entity type:Organization
Organization Name:SAGEBRUSH DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:
Authorized Official - Last Name:JURGES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-436-8202
Mailing Address - Street 1:1335 PITCHER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-9448
Mailing Address - Country:US
Mailing Address - Phone:360-620-7266
Mailing Address - Fax:
Practice Address - Street 1:1114 N MISSION ST STE C
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6711
Practice Address - Country:US
Practice Address - Phone:509-436-8202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-24
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122400000XDental ProvidersDenturistGroup - Multi-Specialty