Provider Demographics
NPI:1326434085
Name:JER LLC
Entity Type:Organization
Organization Name:JER LLC
Other - Org Name:MAIN STREET DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-527-0716
Mailing Address - Street 1:99 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2910
Mailing Address - Country:US
Mailing Address - Phone:901-527-0716
Mailing Address - Fax:901-527-0718
Practice Address - Street 1:99 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2910
Practice Address - Country:US
Practice Address - Phone:901-527-0716
Practice Address - Fax:901-527-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007994261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental