Provider Demographics
NPI:1669675021
Name:GERACI, TIMOTHY F (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:GERACI
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 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 905
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-465-4060
Mailing Address - Fax:510-465-4395
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 905
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-465-4060
Practice Address - Fax:510-465-4395
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-2236630OtherTAX IDENTIFICATION NUMBER