Provider Demographics
NPI:1912996737
Name:GERACCI, GARY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:GERACCI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 POPOLO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1509
Mailing Address - Country:US
Mailing Address - Phone:702-523-1833
Mailing Address - Fax:
Practice Address - Street 1:185 POPOLO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-1509
Practice Address - Country:US
Practice Address - Phone:702-523-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-51C1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery