Provider Demographics
NPI:1558349472
Name:GAO, JERRY P (DDS)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:P
Last Name:GAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PENG
Other - Middle Name:
Other - Last Name:GAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:10475 MONTGOMERY RD
Mailing Address - Street 2:2 J
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5201
Mailing Address - Country:US
Mailing Address - Phone:513-791-0030
Mailing Address - Fax:513-791-0031
Practice Address - Street 1:10475 MONTGOMERY RD
Practice Address - Street 2:2 J
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5201
Practice Address - Country:US
Practice Address - Phone:513-791-0030
Practice Address - Fax:513-791-0031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice