MEDICARE: DR. GEORGE MARK GEKAS 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		IL

General Provider Information

NPI Number	:	1871633396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE MARK GEKAS DDS

Provider Business Mailing Address
First Line	:	616 WEST LAWRENCE AVENUE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-2628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 WEST LAWRENCE AVENUE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-2628
Country	:	US
Telephone Number	:	217-525-0048
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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