=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134560519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ERIC CERCEK D.M.D. M.S.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2013
-----------------------------------------------------
Last Update Date | 06/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6880 S MCCARRAN BLVD STE 14
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-6129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-460-9421
-----------------------------------------------------
Fax | 775-460-9422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2585 SHARON WAY
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-3542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-815-1653
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 6437
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | S7-98
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6437
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------