Provider Demographics
NPI:1588312656
Name:BERMUDEZ, JANELLA (DDS)
Entity type:Individual
Prefix:
First Name:JANELLA
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N ARTHUR ST APT C201
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6129
Mailing Address - Country:US
Mailing Address - Phone:509-531-4393
Mailing Address - Fax:
Practice Address - Street 1:2611 S QUILLAN PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1899
Practice Address - Country:US
Practice Address - Phone:509-585-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARR611975371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice