Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS017739L | PA |
NPI | 1174614168 |
---|---|
Provider Name | Dr. Gerald J Kazmerski |
First Address | Scranton, PA 18509 |
Second Address | Scranton, PA 18509-3023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 17/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1010505830003 | (05) | PA |