Provider Demographics
NPI:1376644161
Name:MCCARTHY, JEROME EDGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:EDGAR
Last Name:MCCARTHY
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 1:5825 S SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-3264
Mailing Address - Country:US
Mailing Address - Phone:315-492-1213
Mailing Address - Fax:
Practice Address - Street 1:5825 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-3264
Practice Address - Country:US
Practice Address - Phone:315-492-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist