Provider Demographics
NPI:1639192073
Name:AZIA, JEROME MORRIS (DDS,)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:MORRIS
Last Name:AZIA
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 1:5 FALCON CRST
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9346
Mailing Address - Country:US
Mailing Address - Phone:413-265-1673
Mailing Address - Fax:
Practice Address - Street 1:5 FALCON CRST
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9346
Practice Address - Country:US
Practice Address - Phone:413-265-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist