Provider Demographics
NPI:1457360364
Name:FAIST, JEROME LIVINGSTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:LIVINGSTON
Last Name:FAIST
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 1:3690 ORANGE PLACE DRIVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-464-2448
Mailing Address - Fax:216-292-2532
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:SUITE 515
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:216-464-2448
Practice Address - Fax:216-292-2532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice