Provider Demographics
NPI:1780606822
Name:JERONIMUS, DONALD JOHN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOHN
Last Name:JERONIMUS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1241
Mailing Address - Country:US
Mailing Address - Phone:763-425-6400
Mailing Address - Fax:763-425-1831
Practice Address - Street 1:10 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1241
Practice Address - Country:US
Practice Address - Phone:763-425-6400
Practice Address - Fax:763-425-1831
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND74271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry