Provider Demographics
NPI:1174676639
Name:URELL, JEROME M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:M
Last Name:URELL
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 1:9 LYONSGATE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1480
Mailing Address - Country:US
Mailing Address - Phone:614-258-8136
Mailing Address - Fax:
Practice Address - Street 1:6023 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-864-6000
Practice Address - Fax:614-864-9250
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice