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General NPI Number Information
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NPI Number | 1285905935
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Entity Type | Organization
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Legal Business Name | JEROMY W. DAUPHIN PLLC
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 2113 N LOY LAKE RD
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City | SHERMAN
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State | TX
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Zip | 75090-2808
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Country | US
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Telephone | 903-893-4224
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Fax | 903-868-9493
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Provider Business Mailing Address
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Address Line | 2113 N LOY LAKE RD
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City | SHERMAN
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State | TX
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Zip | 75090-2808
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Country | US
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Telephone | 903-893-4224
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Fax | 903-868-9493
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEROMY WADE DAUPHIN
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Credential | DDS
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Telephone | 903-893-4224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24108
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License Number State | TX
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