Provider Demographics
NPI:1316556053
Name:ALE, JERDIE MANUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JERDIE
Middle Name:MANUEL
Last Name:ALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JERDIE
Other - Middle Name:MANUEL
Other - Last Name:ALE-SALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11867 MASON MONTGOMERY RD STE 7B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-4712
Mailing Address - Country:US
Mailing Address - Phone:513-677-0383
Mailing Address - Fax:
Practice Address - Street 1:11867 MASON MONTGOMERY RD STE 7B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-4712
Practice Address - Country:US
Practice Address - Phone:513-677-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002383-151223G0001X
OH30.0269781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice