Provider Demographics
NPI:1235634205
Name:FERRIS, GERALDINE MACKOUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:MACKOUL
Last Name:FERRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 SHEPARD ST APT 505
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3284
Mailing Address - Country:US
Mailing Address - Phone:407-497-0298
Mailing Address - Fax:
Practice Address - Street 1:2280 SHEPARD ST APT 505
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3284
Practice Address - Country:US
Practice Address - Phone:407-497-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN83851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics