Provider Demographics
NPI:1114095122
Name:JOHNS, JEROME E (DMD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:E
Last Name:JOHNS
Suffix:
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 1:2402 ROUTE 66 SUITE 105
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-2313
Mailing Address - Country:US
Mailing Address - Phone:724-468-5020
Mailing Address - Fax:724-468-4420
Practice Address - Street 1:2402 ROUTE 66 SUITE 105
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-2313
Practice Address - Country:US
Practice Address - Phone:724-468-5020
Practice Address - Fax:724-468-4420
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017222L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice