Provider Demographics
NPI:1649674409
Name:KEARBY, JEROME SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:SCOTT
Last Name:KEARBY
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 1:12120 SAVAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:TX
Mailing Address - Zip Code:75852-3654
Mailing Address - Country:US
Mailing Address - Phone:936-348-3751
Mailing Address - Fax:
Practice Address - Street 1:12120 SAVAGE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:TX
Practice Address - Zip Code:75852-3654
Practice Address - Country:US
Practice Address - Phone:936-348-3751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice