Provider Demographics
NPI:1366675217
Name:GERON, PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:GERON
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 1:320 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2138
Mailing Address - Country:US
Mailing Address - Phone:908-233-8088
Mailing Address - Fax:908-232-4662
Practice Address - Street 1:320 LENOX AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2138
Practice Address - Country:US
Practice Address - Phone:908-233-8088
Practice Address - Fax:908-232-4662
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012208001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery