Provider Demographics
NPI:1285703363
Name:FORETICH, JEROME FRANCIS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:FRANCIS
Last Name:FORETICH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:716 DENBIGH BLVD
Mailing Address - Street 2:SET B - 4
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4414
Mailing Address - Country:US
Mailing Address - Phone:757-877-0775
Mailing Address - Fax:757-877-0773
Practice Address - Street 1:716 DENBIGH BLVD
Practice Address - Street 2:STE B - 4
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4414
Practice Address - Country:US
Practice Address - Phone:757-877-0775
Practice Address - Fax:757-877-0773
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010079671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice