Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 61068 | CA |
Y | 1223P0700X | Prosthodontist | 054459 | NY |
NPI | 1063676641 |
---|---|
Provider Name | Kenneth Gerace |
First Address | Rochester, NY 14624 |
Second Address | Rochester, NY 14624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 10/10/2016 |