Provider Demographics
NPI:1023119260
Name:TURNER, JEROME GLENN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:GLENN
Last Name:TURNER
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 1:295 MARINA ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2244
Mailing Address - Country:US
Mailing Address - Phone:805-772-7303
Mailing Address - Fax:805-772-2364
Practice Address - Street 1:295 MARINA ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2244
Practice Address - Country:US
Practice Address - Phone:805-772-7303
Practice Address - Fax:805-772-2364
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist