Provider Demographics
NPI:1770632754
Name:COVEL, JEROME ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ANTHONY
Last Name:COVEL
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 1:120 BEULAH RD NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4745
Mailing Address - Country:US
Mailing Address - Phone:703-938-2000
Mailing Address - Fax:703-938-9447
Practice Address - Street 1:120 BEULAH RD NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4745
Practice Address - Country:US
Practice Address - Phone:703-938-2000
Practice Address - Fax:703-938-9447
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010035941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice