Provider Demographics
NPI:1033208251
Name:AXLER, JERROLD H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:H
Last Name:AXLER
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 1:1150 VALLEY FORGE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460
Mailing Address - Country:US
Mailing Address - Phone:610-933-3342
Mailing Address - Fax:610-983-9122
Practice Address - Street 1:1150 VALLEY FORGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2658
Practice Address - Country:US
Practice Address - Phone:610-933-3342
Practice Address - Fax:610-983-9122
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0161071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA639648OtherUNITED CONCORDIA ID#
PA232628134OtherTIN