Healthcare Provider Details

I. General information

NPI: 1619053105
Provider Name (Legal Business Name): IGNATIUS NATE GERODIAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 UNION ST STE 240
SAN FRANCISCO CA
94123-4107
US

IV. Provider business mailing address

38 AMARYLLIS CT
SOUTH SAN FRANCISCO CA
94080-2265
US

V. Phone/Fax

Practice location:
  • Phone: 415-447-1880
  • Fax:
Mailing address:
  • Phone: 650-588-8641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number54617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: