MEDICARE: GARY GERSH 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30012462	OH

General Provider Information

NPI Number	:	1528468352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY GERSH D.D.S.

Provider Business Mailing Address
First Line	:	7575 PELICAN BAY BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34108-7532
Country	:	US
Telephone Number	:	239-566-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	5211 WAYNETOWNE CT
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-2124
Country	:	US
Telephone Number	:	937-278-7417
Fax Number	:

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

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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