Provider Demographics
NPI:1841429313
Name:JARDIN, JERAMEL GERONIMO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERAMEL
Middle Name:GERONIMO
Last Name:JARDIN
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 1:5105 BANCROFT DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4204
Mailing Address - Country:US
Mailing Address - Phone:619-261-8838
Mailing Address - Fax:
Practice Address - Street 1:2340 E 8TH ST STE H
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2877
Practice Address - Country:US
Practice Address - Phone:619-470-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist