Provider Demographics
NPI:1427780287
Name:JEROME, DREW WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:WILLIAM
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 1:22487 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2453
Mailing Address - Country:US
Mailing Address - Phone:313-920-6229
Mailing Address - Fax:
Practice Address - Street 1:15400 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6327
Practice Address - Country:US
Practice Address - Phone:586-228-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016013741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice