Provider Demographics
NPI:1619053105
Name:GERODIAS, IGNATIUS NATE (DDS)
Entity Type:Individual
Prefix:DR
First Name:IGNATIUS
Middle Name:NATE
Last Name:GERODIAS
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 1:38 AMARYLLIS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2265
Mailing Address - Country:US
Mailing Address - Phone:650-588-8641
Mailing Address - Fax:
Practice Address - Street 1:2001 UNION ST STE 240
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4107
Practice Address - Country:US
Practice Address - Phone:415-447-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry