Provider Demographics
NPI:1780985747
Name:OCAMPO, JEROME MENDIOLA (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:MENDIOLA
Last Name:OCAMPO
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 1:22421 BARTON RD # 291
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5008
Mailing Address - Country:US
Mailing Address - Phone:909-783-4059
Mailing Address - Fax:909-783-4095
Practice Address - Street 1:22421 BARTON RD # 291
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5008
Practice Address - Country:US
Practice Address - Phone:909-783-4059
Practice Address - Fax:909-783-4095
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist