Provider Demographics
NPI:1568674109
Name:CERCEK, JOHN FRANK JR (DMD MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANK
Last Name:CERCEK
Suffix:JR
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:F
Other - Last Name:CERCEK
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD MS
Mailing Address - Street 1:805 WEST 7TH STREET
Mailing Address - Street 2:#202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2795
Mailing Address - Country:US
Mailing Address - Phone:775-322-5122
Mailing Address - Fax:775-322-7038
Practice Address - Street 1:805 WEST 7TH STREET
Practice Address - Street 2:#202
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2795
Practice Address - Country:US
Practice Address - Phone:775-322-5122
Practice Address - Fax:775-322-7038
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS4 031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics