Provider Demographics
NPI:1629220868
Name:POLICARPIO, JAIME L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:L
Last Name:POLICARPIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9944 MILBURN DR
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-4245
Mailing Address - Country:US
Mailing Address - Phone:818-450-6903
Mailing Address - Fax:
Practice Address - Street 1:9944 MILBURN DR
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-4245
Practice Address - Country:US
Practice Address - Phone:818-450-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice