MEDICARE: JEROME DENTAL, MICHAEL PAPPAS, DDS, LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1982445235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEROME DENTAL, MICHAEL PAPPAS, DDS, LLC

Provider Business Mailing Address
First Line	:	5775 HOOVER RD STE A
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-7693
Country	:	US
Telephone Number	:	614-967-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 HOOVER RD STE A
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-7693
Country	:	US
Telephone Number	:	614-967-9199
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL CHRISTOPHER PAPPAS
Credential	:	DDS
Telephone Number	:	440-341-9233

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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