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General NPI Number Information
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NPI Number | 1124464417
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Entity Type | Organization
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Legal Business Name | MARK A GERGER DMD INC
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 2235 W ROSECRANS AVE
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City | GARDENA
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State | CA
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Zip | 90249-2905
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Country | US
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Telephone | 310-771-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 2235 W ROSECRANS AVE
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City | GARDENA
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State | CA
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Zip | 90249-2905
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Country | US
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Telephone | 310-771-0990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK GERGER
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Credential | D.M.D.
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Telephone | 310-771-0990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 55310
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License Number State | CA
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