Provider Demographics
NPI:1114092434
Name:MOROF, JERRY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:B
Last Name:MOROF
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 1:27676 CHERRY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-3195
Mailing Address - Country:US
Mailing Address - Phone:734-427-2880
Mailing Address - Fax:734-427-6958
Practice Address - Street 1:27676 CHERRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-3195
Practice Address - Country:US
Practice Address - Phone:734-427-2880
Practice Address - Fax:734-427-6958
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901006890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4011540Medicaid
MID068900OtherBLUE CROSS BLUE SHIELD OF