Provider Demographics
NPI:1235253956
Name:JEROME S MEHLER DDS PLLC
Entity Type:Organization
Organization Name:JEROME S MEHLER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PLLC
Authorized Official - Phone:248-348-7997
Mailing Address - Street 1:42927 W 7 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2277
Mailing Address - Country:US
Mailing Address - Phone:248-348-7997
Mailing Address - Fax:248-348-0119
Practice Address - Street 1:42927 W 7 MILE ROAD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2277
Practice Address - Country:US
Practice Address - Phone:248-348-7997
Practice Address - Fax:248-348-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI107031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty