Provider Demographics
NPI:1336307552
Name:DUNCAN, JEROME B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:B
Last Name:DUNCAN
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 1:9740 MAIN STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3942
Mailing Address - Country:US
Mailing Address - Phone:770-926-6197
Mailing Address - Fax:770-926-6193
Practice Address - Street 1:9740 MAIN STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3942
Practice Address - Country:US
Practice Address - Phone:770-926-6197
Practice Address - Fax:770-926-6193
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA73011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice