Provider Demographics
NPI:1588652507
Name:DEMOREST, JOHN WARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARREN
Last Name:DEMOREST
Suffix:
Gender:M
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:PO BOX 1659
Mailing Address - Street 2:33 EAST GRASS VALLEY STREET
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-1659
Mailing Address - Country:US
Mailing Address - Phone:530-346-2214
Mailing Address - Fax:
Practice Address - Street 1:33 E GRASS VALLEY ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-1659
Practice Address - Country:US
Practice Address - Phone:530-346-2214
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist