Provider Demographics
NPI:1497974836
Name:RAMISCAL, JAIME A (DDS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:A
Last Name:RAMISCAL
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 1:1444 N POINSETTIA PL
Mailing Address - Street 2:102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4364
Mailing Address - Country:US
Mailing Address - Phone:323-876-5820
Mailing Address - Fax:
Practice Address - Street 1:8023 BEVERLY BLVD
Practice Address - Street 2:# 3
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-4539
Practice Address - Country:US
Practice Address - Phone:323-782-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41525122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice