Provider Demographics
NPI:1396853578
Name:CLORE, JERRY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:CLORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 68TH STREET SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-281-1331
Mailing Address - Fax:616-281-4276
Practice Address - Street 1:334 68TH STREET SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548
Practice Address - Country:US
Practice Address - Phone:616-281-1331
Practice Address - Fax:616-281-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID14591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist