Provider Demographics
NPI:1114065133
Name:IMRAY & GESEK DMD PA
Entity Type:Organization
Organization Name:IMRAY & GESEK DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GESEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-388-7665
Mailing Address - Street 1:2047 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3809
Mailing Address - Country:US
Mailing Address - Phone:904-388-7665
Mailing Address - Fax:904-388-7664
Practice Address - Street 1:2047 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3809
Practice Address - Country:US
Practice Address - Phone:904-388-7665
Practice Address - Fax:904-388-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 0013575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty