Provider Demographics
NPI:1568667830
Name:TAFOLLA, JEROME (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:TAFOLLA
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 1:5478 TOMAH DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-598-6680
Mailing Address - Fax:719-598-4037
Practice Address - Street 1:5478 TOMAH DRIVE
Practice Address - Street 2:PEAK VISTA FAMILY DENTISTRY
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-598-6680
Practice Address - Fax:719-598-4037
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist