Provider Demographics
NPI:1013000363
Name:WARCHOL, JEROME STEPHEN SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:STEPHEN
Last Name:WARCHOL
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N BELT E
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5009
Mailing Address - Country:US
Mailing Address - Phone:618-277-9558
Mailing Address - Fax:
Practice Address - Street 1:1620 N BELT E
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-5009
Practice Address - Country:US
Practice Address - Phone:618-277-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice