Provider Demographics
NPI:1912074345
Name:JEROME, CHARLES EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:JEROME
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 1:488 EAST VALLEY PARKWAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3373
Mailing Address - Country:US
Mailing Address - Phone:760-739-1400
Mailing Address - Fax:760-739-1100
Practice Address - Street 1:488 EAST VALLEY PARKWAY
Practice Address - Street 2:SUITE 307
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3373
Practice Address - Country:US
Practice Address - Phone:760-739-1400
Practice Address - Fax:760-739-1100
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372371223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics