MEDICARE: DR. GERALDINE MACKOUL FERRIS DMD

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	1223P0300X	Periodontics	DN8385	FL

General Provider Information

NPI Number	:	1235634205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALDINE MACKOUL FERRIS DMD

Provider Business Mailing Address
First Line	:	2280 SHEPARD ST APT 505
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3284
Country	:	US
Telephone Number	:	407-497-0298
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 SHEPARD ST APT 505
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3284
Country	:	US
Telephone Number	:	407-497-0298
Fax Number	:

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/29/2018

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