DR. Derick Jack Sovereign, DMD

NPI #1245073287 in Wasilla, Alaska

Provider Information

NPI Number
1245073287
Entity Type
Individual
Name
DR. Derick Jack Sovereign, DMD
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dentist
Credential
DMD
Enumeration Date
Jun 17, 2024
Last Updated
Jun 17, 2024

Practice Location

Address
3765 E BLUE LUPINE DR STE A
State
Alaska
ZIP Code
99654-8417
Phone
(480) 341-0791

Specialties & Taxonomy Codes

Specialty
Dentist

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