Provider Demographics
NPI:1134560519
Name:CERCEK, JOHN ERIC (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:CERCEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3636
Mailing Address - Country:US
Mailing Address - Phone:775-815-1653
Mailing Address - Fax:
Practice Address - Street 1:780 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3636
Practice Address - Country:US
Practice Address - Phone:775-815-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV64371223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223E0200XDental ProvidersDentistEndodontics