MEDICARE: DR. GEORGE J GERDTS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9434	FL

General Provider Information

NPI Number	:	1114917861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE J GERDTS DDS

Provider Business Mailing Address
First Line	:	10622 GREAT ARBOR DR
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-4219
Country	:	US
Telephone Number	:	301-983-0343
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 BROOKLEY AVE
Second Line	:
City	:	BOLLING AFB
State	:	DC
Zip	:	20332-0001
Country	:	US
Telephone Number	:	202-404-3603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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