MEDICARE: ROBERT B GERBER DDS A PROF CORP

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	16153	CA

General Provider Information

NPI Number	:	1679763916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT B GERBER DDS A PROF CORP

Provider Business Mailing Address
First Line	:	8631 WEST THIRD STREET
Second Line	:	SUITE 730E
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:	310-652-0450
Fax Number	:	310-652-0458

Provider Business Practice Location Address
First Line	:	8631 WEST THIRD STREET
Second Line	:	SUITE 730E
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5911
Country	:	US
Telephone Number	:	310-652-0450
Fax Number	:	310-652-0458

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT BURTON GERBER
Credential	:	DDS
Telephone Number	:	310-652-0450

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/16/2007

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