Provider Demographics
NPI:1770649972
Name:HERMES, H H (DDS)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:H
Last Name:HERMES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:H
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1530 JAMACHA RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3700
Mailing Address - Country:US
Mailing Address - Phone:619-447-6464
Mailing Address - Fax:619-447-0701
Practice Address - Street 1:1530 JAMACHA RD
Practice Address - Street 2:SUITE L
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3700
Practice Address - Country:US
Practice Address - Phone:619-447-6464
Practice Address - Fax:619-447-0701
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-2893501Medicaid