Healthcare Provider Details

I. General information

NPI: 1033253448
Provider Name (Legal Business Name): GERARD MICHAEL CUOMO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 13TH ST SUITE 300
BOCA RATON FL
33486-2335
US

IV. Provider business mailing address

17756 OAKWOOD AVE
BOCA RATON FL
33487-2211
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-6290
  • Fax: 561-391-6299
Mailing address:
  • Phone: 561-995-0790
  • Fax: 561-995-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 10019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: