Provider Demographics
NPI:1871508358
Name:A J GERATHY JR DMD LLC
Entity Type:Organization
Organization Name:A J GERATHY JR DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERATHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-481-4949
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132
Mailing Address - Country:US
Mailing Address - Phone:719-481-4949
Mailing Address - Fax:
Practice Address - Street 1:325 SECOND STREET
Practice Address - Street 2:SUITE A
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:719-481-4949
Practice Address - Fax:719-481-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty