MEDICARE: MARCO GERIS

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	122300000X	Dentist	DN27963	FL

General Provider Information

NPI Number	:	1578255782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO GERIS

Provider Business Mailing Address
First Line	:	841 WINDING OAKS DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 WINDING OAKS DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6612
Country	:	US
Telephone Number	:	727-709-1692
Fax Number	:

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

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/26/2023

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Directions to “ MARCO GERIS ” Practice Location

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