Healthcare Provider Details

I. General information

NPI: 1891737813
Provider Name (Legal Business Name): MICHAEL SCOTT GERIC D.M.D, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10870 SHELDON RD
TAMPA FL
33626-5117
US

IV. Provider business mailing address

10870 SHELDON RD
TAMPA FL
33626-5117
US

V. Phone/Fax

Practice location:
  • Phone: 813-920-7720
  • Fax: 813-920-5331
Mailing address:
  • Phone: 813-920-7720
  • Fax: 813-920-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN13400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: