Provider Demographics
NPI:1851516132
Name:ERMITA, MYRA P (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:P
Last Name:ERMITA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 JUNCTION AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2105
Mailing Address - Country:US
Mailing Address - Phone:408-432-1416
Mailing Address - Fax:408-432-1447
Practice Address - Street 1:2055 JUNCTION AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-2105
Practice Address - Country:US
Practice Address - Phone:408-432-1416
Practice Address - Fax:408-432-1447
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice