Provider Demographics
NPI:1811395882
Name:JAMES A JERMAN DDS PLLC
Entity Type:Organization
Organization Name:JAMES A JERMAN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-752-4375
Mailing Address - Street 1:22 2ND AVE W
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4466
Mailing Address - Country:US
Mailing Address - Phone:406-752-4375
Mailing Address - Fax:406-756-6471
Practice Address - Street 1:22 2ND AVE W
Practice Address - Street 2:SUITE 1000
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4466
Practice Address - Country:US
Practice Address - Phone:406-752-4375
Practice Address - Fax:406-756-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2442261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1669662722Medicaid