Provider Demographics
NPI:1568766012
Name:MAHFOUZ M. GEREIS DDS, INC
Entity Type:Organization
Organization Name:MAHFOUZ M. GEREIS DDS, INC
Other - Org Name:VAN NUYS PANORAMA DENTAL CENER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHFOUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEREIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-989-3074
Mailing Address - Street 1:8227 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4804
Mailing Address - Country:US
Mailing Address - Phone:818-989-3074
Mailing Address - Fax:
Practice Address - Street 1:8227 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4804
Practice Address - Country:US
Practice Address - Phone:818-989-3074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty