Provider Demographics
NPI:1992891576
Name:JERMAIN, PAUL DAVID
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:JERMAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:DAVID
Other - Last Name:JERMAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12052 HESPERIA RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1867
Mailing Address - Country:US
Mailing Address - Phone:760-244-0599
Mailing Address - Fax:760-244-0641
Practice Address - Street 1:12052 HESPERIA RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1867
Practice Address - Country:US
Practice Address - Phone:760-244-0599
Practice Address - Fax:760-244-0641
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice