MEDICARE: GERMAIN JEAN-CHARLES DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1114542792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERMAIN JEAN-CHARLES DDS PC

Provider Business Mailing Address
First Line	:	25 HIGHVIEW TRL
Second Line	:
City	:	PITTSFORD
State	:	NY
Zip	:	14534-3441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 N MAIN ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1030
Country	:	US
Telephone Number	:	585-394-5910
Fax Number	:

Authorized Official
Title or Position	:	CONSULTANT
Name	:	IULIA RUS
Credential	:
Telephone Number	:	301-204-6956

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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