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General NPI Number Information
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NPI Number | 1558772277
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Entity Type | Organization
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Legal Business Name | GERIK DENTAL, INC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 1305 21ST AVE SUITE #102
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City | FAIRBANKS
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State | AK
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Zip | 99701-6084
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Country | US
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Telephone | 907-456-5665
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Fax | 907-456-1753
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Provider Business Mailing Address
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Address Line | 1305 21ST AVE SUITE #102
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City | FAIRBANKS
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State | AK
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Zip | 99701-6084
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Country | US
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Telephone | 907-456-5665
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Fax | 907-456-1753
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JONATHAN GERIK
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Credential | D.D.S.
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Telephone | 907-456-5665
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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 | 1350
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License Number State | AK
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