Provider Demographics
NPI:1679661276
Name:GERONIMO, ROSALIE S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:S
Last Name:GERONIMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 DRISCOLL RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-4400
Mailing Address - Country:US
Mailing Address - Phone:510-440-1406
Mailing Address - Fax:510-440-8746
Practice Address - Street 1:1956 DRISCOLL RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-4400
Practice Address - Country:US
Practice Address - Phone:510-440-1406
Practice Address - Fax:510-440-8746
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice