Provider Demographics
NPI:1437253812
Name:MC MAHON, JEROME E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:E
Last Name:MC MAHON
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 1:234 GOODMAN ST
Mailing Address - Street 2:ML 0803
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-6656
Mailing Address - Fax:513-584-6651
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:ML 0803
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-6656
Practice Address - Fax:513-584-6651
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0182521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0799846Medicaid
OH0885371Medicare ID - Type Unspecified
OH0799846Medicaid