Provider Demographics
NPI:1366465791
Name:JEROME M. AZIA D.D.S.,P.C.
Entity Type:Organization
Organization Name:JEROME M. AZIA D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:AZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-569-3170
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-0034
Mailing Address - Country:US
Mailing Address - Phone:413-569-3170
Mailing Address - Fax:413-569-3170
Practice Address - Street 1:627 COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9433
Practice Address - Country:US
Practice Address - Phone:413-569-3170
Practice Address - Fax:413-569-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty