Provider Demographics
NPI:1881350932
Name:GERI'S TEETH PLLC
Entity type:Organization
Organization Name:GERI'S TEETH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RICARDO SANCHEZ
Authorized Official - Phone:208-600-4558
Mailing Address - Street 1:13122 S BOW RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6752
Mailing Address - Country:US
Mailing Address - Phone:208-600-4558
Mailing Address - Fax:
Practice Address - Street 1:13122 S BOW RIVER AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6752
Practice Address - Country:US
Practice Address - Phone:208-600-4558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental