Provider Demographics
NPI:1487714788
Name:CERDAN, JEROME V (DMD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:V
Last Name:CERDAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 N THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-2211
Mailing Address - Country:US
Mailing Address - Phone:352-219-3740
Mailing Address - Fax:
Practice Address - Street 1:1003 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-2211
Practice Address - Country:US
Practice Address - Phone:352-219-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 177731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice