DERICK JACK SOVEREIGN

WASILLA, AK
NPI1245073287
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy122300000X Dentist
(Licence: AK  224623)
Enumeration Date2024-06-17
Last Update Date2024-06-17
Business Address
Dr. DERICK JACK SOVEREIGN DMD
3765 E BLUE LUPINE DR STE A
WASILLA, AK 99654-8417
Phone number: 480-341-0791
Mailing Address
Dr. DERICK JACK SOVEREIGN DMD
3765 E BLUE LUPINE DR STE A
WASILLA, AK 99654-8417
Phone number: 480-341-0791
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