Healthcare Provider Details

I. General information

NPI: 1669572269
Provider Name (Legal Business Name): PAUL GEROMETTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 W QUEEN ST
STRASBURG VA
22657-2226
US

IV. Provider business mailing address

279 W QUEEN ST
STRASBURG VA
22657-2226
US

V. Phone/Fax

Practice location:
  • Phone: 540-465-5622
  • Fax: 540-465-3285
Mailing address:
  • Phone: 540-465-5622
  • Fax: 540-465-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4416
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: