Individual
DR. JEROME TABACCA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1707 BETHEL RD, COLUMBUS, OH 43220-1810
(614) 459-0050
(614) 459-1955
Mailing address
1707 BETHEL RD, COLUMBUS, OH 43220-1810
(614) 459-0050
(614) 459-1955
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
OH14335
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
432538
UNITED CONCORDIA
WV
Enumeration date
06/01/2005
Last updated
07/08/2007
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