MEDICARE: DR. GARY RAY ACKERMAN DDS

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
1	122300000X	Dentist	34811	CA

General Provider Information

NPI Number	:	1407974025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY RAY ACKERMAN DDS

Provider Business Mailing Address
First Line	:	6600 MADISON AVE
Second Line	:	SUITE 8
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0645
Country	:	US
Telephone Number	:	916-961-5464
Fax Number	:	916-961-5927

Provider Business Practice Location Address
First Line	:	6600 MADISON AVE
Second Line	:	SUITE 8
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0645
Country	:	US
Telephone Number	:	916-961-5464
Fax Number	:	916-961-5927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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