MEDICARE: JENNIFER JEAN JEROME D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21472	OH

General Provider Information

NPI Number	:	1578622510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JEAN JEROME D.D.S.

Provider Business Mailing Address
First Line	:	1865 BROWN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-3107
Country	:	US
Telephone Number	:	330-724-4093
Fax Number	:	330-724-7104

Provider Business Practice Location Address
First Line	:	1865 BROWN ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44301-3107
Country	:	US
Telephone Number	:	330-724-4093
Fax Number	:	330-724-7104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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