Basic Information
| Provider Information | |||||||||
| NPI: | 1679186134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAGERS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MARIANO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 W 1ST ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852812726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757709048 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3042 W QUEEN CREEK RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852482815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207962600 | ||||||||
| FaxNumber: | 6025281255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2020 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D010803 | AZ | Y | Dental Providers | Dentist |
No ID Information.