Provider Demographics
NPI:1225111669
Name:GEVIRTZ, DAVID JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:GEVIRTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 HORSHAM RD # A
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1207
Mailing Address - Country:US
Mailing Address - Phone:215-443-7400
Mailing Address - Fax:215-443-0760
Practice Address - Street 1:623 HORSHAM RD # A
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1207
Practice Address - Country:US
Practice Address - Phone:215-443-7400
Practice Address - Fax:215-443-0760
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024061L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice