MEDICARE: DR. GARY JAMES GERACCI 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	S2-51C	NV

General Provider Information

NPI Number	:	1912996737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY JAMES GERACCI DDS

Provider Business Mailing Address
First Line	:	185 POPOLO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1509
Country	:	US
Telephone Number	:	702-523-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 POPOLO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-1509
Country	:	US
Telephone Number	:	702-523-1833
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/07/2012

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