Provider Demographics
NPI:1760830798
Name:GERA, YOGESH
Entity Type:Individual
Prefix:
First Name:YOGESH
Middle Name:
Last Name:GERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-1344
Mailing Address - Country:US
Mailing Address - Phone:816-632-6700
Mailing Address - Fax:
Practice Address - Street 1:417 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-1344
Practice Address - Country:US
Practice Address - Phone:816-632-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160175261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice