Provider Demographics
NPI:1750520292
Name:SAYRE, JEREMY MITCHELL (DMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MITCHELL
Last Name:SAYRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 RAVALLI ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2101
Mailing Address - Country:US
Mailing Address - Phone:406-585-1443
Mailing Address - Fax:406-585-2407
Practice Address - Street 1:4350 RAVALLI ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2101
Practice Address - Country:US
Practice Address - Phone:406-585-1443
Practice Address - Fax:406-585-2407
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics