Provider Demographics
NPI:1558900605
Name:GERMAIN JEAN-CHARLES DDS PC
Entity Type:Organization
Organization Name:GERMAIN JEAN-CHARLES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-394-5910
Mailing Address - Street 1:25 HIGHVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3441
Mailing Address - Country:US
Mailing Address - Phone:718-812-2869
Mailing Address - Fax:
Practice Address - Street 1:344 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1030
Practice Address - Country:US
Practice Address - Phone:585-394-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03501984Medicaid