Provider Demographics
NPI:1518379122
Name:ZERMENO, JOHN PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:ZERMENO
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 1:8555 FLETCHER PKWY
Mailing Address - Street 2:#102
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8555 FLETCHER PKWY
Practice Address - Street 2:#102
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3060
Practice Address - Country:US
Practice Address - Phone:619-337-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97641223G0001X
CA636331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice