Provider Demographics
NPI:1841416906
Name:USHEROFF, JEROME MONTAGUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:MONTAGUE
Last Name:USHEROFF
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 1:155 N. MICHIGAN AVE
Mailing Address - Street 2:#323
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-565-0014
Mailing Address - Fax:312-565-0013
Practice Address - Street 1:155 N MICHIGAN AVE
Practice Address - Street 2:#323
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7511
Practice Address - Country:US
Practice Address - Phone:312-565-0014
Practice Address - Fax:312-565-0013
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist