MEDICARE: DR. AARON P GERSON D.D.S.

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	30553	CA

General Provider Information

NPI Number	:	1306952130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON P GERSON D.D.S.

Provider Business Mailing Address
First Line	:	1221 HIGHLAND AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-4753
Country	:	US
Telephone Number	:	310-545-4561
Fax Number	:	310-545-4562

Provider Business Practice Location Address
First Line	:	1221 HIGHLAND AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-4753
Country	:	US
Telephone Number	:	310-545-4561
Fax Number	:	310-545-4562

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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