Provider Demographics
NPI:1760835359
Name:DENMAN, JEREMY A (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:A
Last Name:DENMAN
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 1:8151 DORADO DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8533
Mailing Address - Country:US
Mailing Address - Phone:432-563-5633
Mailing Address - Fax:432-563-5630
Practice Address - Street 1:8151 DORADO DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8533
Practice Address - Country:US
Practice Address - Phone:432-563-5633
Practice Address - Fax:432-563-5630
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist