Provider Demographics
NPI:1942440201
Name:JEROME L. FAIST DDS, INC
Entity Type:Organization
Organization Name:JEROME L. FAIST DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-464-2448
Mailing Address - Street 1:3690 ORANGE PL STE 515
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4466
Mailing Address - Country:US
Mailing Address - Phone:216-464-2448
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL STE 515
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4466
Practice Address - Country:US
Practice Address - Phone:216-464-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty