Provider Demographics
NPI:1023275021
Name:SUGARMAN, JERROLD L (DDS)
Entity type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:L
Last Name:SUGARMAN
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 1:11200 CORBIN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4120
Mailing Address - Country:US
Mailing Address - Phone:818-831-6503
Mailing Address - Fax:818-831-6527
Practice Address - Street 1:11200 CORBIN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4120
Practice Address - Country:US
Practice Address - Phone:818-831-6503
Practice Address - Fax:818-831-6527
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist