Provider Demographics
NPI:1558772277
Name:GERIK DENTAL, INC
Entity Type:Organization
Organization Name:GERIK DENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-456-5665
Mailing Address - Street 1:1305 21ST AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6084
Mailing Address - Country:US
Mailing Address - Phone:907-456-5665
Mailing Address - Fax:907-456-1753
Practice Address - Street 1:1305 21ST AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6084
Practice Address - Country:US
Practice Address - Phone:907-456-5665
Practice Address - Fax:907-456-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1350261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1601351Medicaid