Provider Demographics
NPI:1134348956
Name:GEVERTZ, RANDEE (DMD)
Entity type:Individual
Prefix:DR
First Name:RANDEE
Middle Name:
Last Name:GEVERTZ
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 1:879 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764
Mailing Address - Country:US
Mailing Address - Phone:732-222-0977
Mailing Address - Fax:732-222-0208
Practice Address - Street 1:879 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST LONG BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-222-0977
Practice Address - Fax:732-222-0208
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ131441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice