Jerome V Cerdan, DMD
Individual provider Active NPI General Practice Dentistry · Starke, FL
NPI 1487714788 · NPPES record last updated Jul 14, 2010
Key facts
- NPI
- 1487714788
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN 17773 (FL)
- Practice address
- 1003 N Thompson St
Starke, FL 32091-2211 - Phone
- (352) 219-3740
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160412002443 | FL | Order and Referring Only - Dentist |
3375841125 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN 17773 | FL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN 17773 | FL | Yes |
Addresses
Primary practice location
1003 N Thompson St
Starke, FL 32091-2211
Mailing address
1003 N Thompson St
Starke, FL 32091-2211
Phone (352) 219-3740
Other providers in Starke, FL
- Shira Callahan
- Jean Callaway
- Cardiolog Associates of Gainesville
- Cardiology Associates of Gainesville
- Jessica Luckado Caveny
- Childrens Home Society
- Jacki Shehan Clark
- Tricia Lawson Clark
- Angela Coggins-Anderson
- Susan Dianne Colby
All providers in Starke, FL · General Practice Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.