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General NPI Number Information
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NPI Number | 1083132567
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Entity Type | Organization
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Legal Business Name | CHRIS V GEROFF DDS PC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 195 MAIN STREET
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City | GAINESVILLE
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State | MO
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Zip | 65655
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Country | US
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Telephone | 417-679-3509
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Fax | 417-679-0200
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Provider Business Mailing Address
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Address Line | PO BOX 660
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City | GAINESVILLE
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State | MO
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Zip | 65655-0660
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Country | US
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Telephone | 417-679-3509
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Fax | 417-679-0200
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Authorized Official
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Title or Position | OWNER
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Name | CHRIS GEROFF
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Credential | DDS
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Telephone | 417-679-3509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE010823
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License Number State | MO
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