Provider Demographics
NPI:1578622510
Name:JEROME, JENNIFER JEAN (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:JEROME
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-3107
Mailing Address - Country:US
Mailing Address - Phone:330-724-4093
Mailing Address - Fax:330-724-7104
Practice Address - Street 1:1865 BROWN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-3107
Practice Address - Country:US
Practice Address - Phone:330-724-4093
Practice Address - Fax:330-724-7104
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH214721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice