Provider Demographics
NPI:1962660183
Name:JEROME B DUNCAN DDS PC
Entity Type:Organization
Organization Name:JEROME B DUNCAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-926-6197
Mailing Address - Street 1:9740 MAIN STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3942
Mailing Address - Country:US
Mailing Address - Phone:770-926-6197
Mailing Address - Fax:770-926-6193
Practice Address - Street 1:9740 MAIN STREET
Practice Address - Street 2:SUITE 140
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3942
Practice Address - Country:US
Practice Address - Phone:770-926-6197
Practice Address - Fax:770-926-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty