Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 37553 | GA |
NPI | 1083773048 |
---|---|
Provider Name | Janice Lynn Gerber |
First Address | Fairfield, CA 94534 |
Second Address | Fairfield, CA 94534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |