Healthcare Provider Details

I. General information

NPI: 1831380302
Provider Name (Legal Business Name): CAROLINE K JERMANUS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD GRAD PERIODONTICS
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

2635 SW 35TH PL #901
GAINESVILLE FL
32608-3294
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7846
  • Fax:
Mailing address:
  • Phone: 352-373-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN17967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: