Provider Demographics
NPI:1598312126
Name:FLAKE-WARMOTH, JASMINE ROXANNA (DDS)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ROXANNA
Last Name:FLAKE-WARMOTH
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 1:2 TOWNSEND ST APT 2-1005
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-4010
Mailing Address - Country:US
Mailing Address - Phone:650-492-0098
Mailing Address - Fax:
Practice Address - Street 1:500 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2666
Practice Address - Country:US
Practice Address - Phone:415-221-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist