Provider Demographics
NPI:1285905935
Name:JEROMY W. DAUPHIN PLLC
Entity type:Organization
Organization Name:JEROMY W. DAUPHIN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROMY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DAUPHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-893-4224
Mailing Address - Street 1:2113 N LOY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2808
Mailing Address - Country:US
Mailing Address - Phone:903-893-4224
Mailing Address - Fax:903-868-9493
Practice Address - Street 1:2113 N LOY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2808
Practice Address - Country:US
Practice Address - Phone:903-893-4224
Practice Address - Fax:903-868-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty