Provider Demographics
NPI:1083052989
Name:ERMINY, VICTOR (DDS)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:ERMINY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10297 INNOVATION WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8030
Mailing Address - Country:US
Mailing Address - Phone:216-681-9345
Mailing Address - Fax:
Practice Address - Street 1:4689 HWY 17 # 6
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6640
Practice Address - Country:US
Practice Address - Phone:216-681-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30024586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist