Provider Demographics
NPI:1003252941
Name:I. GERODIAS, M. PEREA-CORKISH, AND E. WANG, DDS, INC.
Entity Type:Organization
Organization Name:I. GERODIAS, M. PEREA-CORKISH, AND E. WANG, DDS, INC.
Other - Org Name:DISCOVERY PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNATIUS
Authorized Official - Middle Name:NATE
Authorized Official - Last Name:GERODIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-441-7766
Mailing Address - Street 1:1700 CALIFORNIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4582
Mailing Address - Country:US
Mailing Address - Phone:415-441-7766
Mailing Address - Fax:415-441-1919
Practice Address - Street 1:1700 CALIFORNIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4582
Practice Address - Country:US
Practice Address - Phone:415-441-7766
Practice Address - Fax:415-441-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty