Healthcare Provider Details

I. General information

NPI: 1568674109
Provider Name (Legal Business Name): JOHN FRANK CERCEK JR. DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN F CERCEK JR. DMD MS

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WEST 7TH STREET #202
RENO NV
89503-2795
US

IV. Provider business mailing address

805 WEST 7TH STREET #202
RENO NV
89503-2795
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-5122
  • Fax: 775-322-7038
Mailing address:
  • Phone: 775-322-5122
  • Fax: 775-322-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS4 03
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: