Provider Demographics
NPI:1184760704
Name:MCDERMAID, JEFFREY A (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:MCDERMAID
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 1:13203 E. HADLEY ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601
Mailing Address - Country:US
Mailing Address - Phone:562-693-1004
Mailing Address - Fax:562-639-9110
Practice Address - Street 1:13203 E. HADLEY ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601
Practice Address - Country:US
Practice Address - Phone:562-693-1004
Practice Address - Fax:562-639-9110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice