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NPI Code Detail

MEDICARE: JON GESICKI D.D.S.

MEDICARE: JON GESICKI D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2901021123MI
21223G0001XGeneral Practice DentistryDN20522FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225450216
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON GESICKI D.D.S.
Provider Business Mailing Address
First Line : 5580 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2817
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5580 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2817
Country : US
Telephone Number : 941-914-9181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2014
Last Update Date : 02/08/2018

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Directions to “ JON GESICKI D.D.S.” Practice Location

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