Provider Demographics
NPI:1043350499
Name:GEROME, MARK E (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:GEROME
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 1:6378 BRANCH HILL GUINEA RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140
Mailing Address - Country:US
Mailing Address - Phone:513-677-1349
Mailing Address - Fax:513-677-8331
Practice Address - Street 1:6378 BRANCH HILL GUINEA RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140
Practice Address - Country:US
Practice Address - Phone:513-677-1349
Practice Address - Fax:513-677-8331
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH202831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice