Healthcare Provider Details

I. General information

NPI: 1669662722
Provider Name (Legal Business Name): JAMES JERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 VILLAGE LOOP
KALISPELL MT
59901
US

IV. Provider business mailing address

60 VILLAGE LOOP
KALISPELL MT
59901
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-4375
  • Fax:
Mailing address:
  • Phone: 406-752-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2442
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: