Provider Demographics
NPI:1316832975
Name:SERNA, JAZMIN DE MARIA (DMD)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:DE MARIA
Last Name:SERNA
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 1:16791 ARTESIAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1232
Mailing Address - Country:US
Mailing Address - Phone:708-537-8804
Mailing Address - Fax:
Practice Address - Street 1:1400 W 47TH ST STE 7
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6148
Practice Address - Country:US
Practice Address - Phone:708-482-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190360921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice