Healthcare Provider Details

I. General information

NPI: 1447223672
Provider Name (Legal Business Name): RICHARD RAYMOND GERE D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9197 GREENBACK LN #B
ORANGEVALE CA
95662-4792
US

IV. Provider business mailing address

5418 RAIMER WAY
CARMICHAEL CA
95608-5924
US

V. Phone/Fax

Practice location:
  • Phone: 916-988-1744
  • Fax:
Mailing address:
  • Phone: 916-489-1068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD22603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: