Provider Demographics
NPI:1427198043
Name:RONALDO E FERMIN DMD INC
Entity Type:Organization
Organization Name:RONALDO E FERMIN DMD INC
Other - Org Name:GELLERT DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER DENTIST ADMINISTRATOR AND
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-878-1033
Mailing Address - Street 1:2400 WESTBOROUGH BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5402
Mailing Address - Country:US
Mailing Address - Phone:650-878-1033
Mailing Address - Fax:650-878-1031
Practice Address - Street 1:2400 WESTBOROUGH BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5402
Practice Address - Country:US
Practice Address - Phone:650-878-1033
Practice Address - Fax:650-878-1031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RONALDO E FERMIN DMD INC DBA GELLERT DENTAL OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9080201OtherDENTICAL PROVIDER NO