MEDICARE: MR. JERRY P GAO 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	21245	OH

General Provider Information

NPI Number	:	1558349472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY P GAO DDS

Provider Business Mailing Address
First Line	:	10475 MONTGOMERY RD
Second Line	:	2 J
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5201
Country	:	US
Telephone Number	:	513-791-0030
Fax Number	:	513-791-0031

Provider Business Practice Location Address
First Line	:	10475 MONTGOMERY RD
Second Line	:	2 J
City	:	CINCINNATI
State	:	OH
Zip	:	45242-5201
Country	:	US
Telephone Number	:	513-791-0030
Fax Number	:	513-791-0031

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	07/08/2007

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