Healthcare Provider Details

I. General information

NPI: 1134560519
Provider Name (Legal Business Name): JOHN ERIC CERCEK D.M.D. M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6880 S MCCARRAN BLVD STE 14
RENO NV
89509-6129
US

IV. Provider business mailing address

2585 SHARON WAY
RENO NV
89509-3542
US

V. Phone/Fax

Practice location:
  • Phone: 775-460-9421
  • Fax: 775-460-9422
Mailing address:
  • Phone: 775-815-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6437
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS7-98
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6437
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: