MEDICARE: DR. A J GERATHY JR. DMD

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	1223G0001X	General Practice Dentistry	DEN.00006161	CO

General Provider Information

NPI Number	:	1568424281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. A J GERATHY JR. DMD

Provider Business Mailing Address
First Line	:	3205 N. ACADEMY BLVD. SUITE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:	719-344-7837

Provider Business Practice Location Address
First Line	:	325 2ND ST
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7935
Country	:	US
Telephone Number	:	719-481-4949
Fax Number	:	719-481-4989

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/01/2017

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