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General NPI Number Information
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NPI Number | 1811681190
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Entity Type | Individual
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Provider Name | JERMIN JOSEPH DMD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 1200 W MAIN ST STE 9
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City | PEORIA
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State | IL
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Zip | 61606-1218
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Country | US
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Telephone | 773-499-9385
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Fax |
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Provider Business Mailing Address
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Address Line | 611 MILWAUKEE AVE STE 175
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City | GLENVIEW
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State | IL
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Zip | 60025-7801
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Country | US
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Telephone | 773-499-9385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019034329
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License Number State | IL
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