Provider Demographics
NPI:1316681380
Name:HUGH JERNIGAN, DMD PLLC
Entity type:Organization
Organization Name:HUGH JERNIGAN, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-315-9722
Mailing Address - Street 1:2418 E DESERT COVE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2522
Mailing Address - Country:US
Mailing Address - Phone:602-315-9722
Mailing Address - Fax:
Practice Address - Street 1:7102 E ACOMA DR STE 3
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2771
Practice Address - Country:US
Practice Address - Phone:480-556-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental