Provider Demographics
NPI:1497876544
Name:JANZEN, HERMAN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:E
Last Name:JANZEN
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 1:4747 N. FIRST ST.
Mailing Address - Street 2:#189
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726
Mailing Address - Country:US
Mailing Address - Phone:559-224-3330
Mailing Address - Fax:
Practice Address - Street 1:4747 N. FIRST
Practice Address - Street 2:#189
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726
Practice Address - Country:US
Practice Address - Phone:559-224-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice