Provider Demographics
NPI:1598724288
Name:DOWD, GERARD T (DDS)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:T
Last Name:DOWD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2812
Mailing Address - Country:US
Mailing Address - Phone:215-333-9696
Mailing Address - Fax:215-333-8514
Practice Address - Street 1:9525 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2812
Practice Address - Country:US
Practice Address - Phone:215-333-9696
Practice Address - Fax:215-333-8514
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-015995-L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30994OtherAETNA US HEALTHCARE
PA0060847000OtherKEYSTONE/PERSONAL CHOICE
PA0060847000OtherKEYSTONE/PERSONAL CHOICE
PADO051117Medicare ID - Type Unspecified