Provider Demographics
NPI:1598783078
Name:MASSIMEI, GERALD G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:G
Last Name:MASSIMEI
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 1:5750 ERLANGER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3802
Mailing Address - Country:US
Mailing Address - Phone:858-246-6404
Mailing Address - Fax:
Practice Address - Street 1:5750 ERLANGER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-3802
Practice Address - Country:US
Practice Address - Phone:858-246-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice