MEDICARE: DR. JEREMY GERBER D.M.D.

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	DN16721	FL
2	1223G0001X	General Practice Dentistry	DS036320	PA

General Provider Information

NPI Number	:	1568588580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY GERBER D.M.D.

Provider Business Mailing Address
First Line	:	1332 SE 17TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-763-4403
Fax Number	:	954-763-0989

Provider Business Practice Location Address
First Line	:	1332 SE 17TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1708
Country	:	US
Telephone Number	:	954-763-4403
Fax Number	:	954-763-0989

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/26/2011

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