Provider Demographics
NPI:1154719979
Name:GERECHT, RONALD MORRIS (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MORRIS
Last Name:GERECHT
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 1:2031 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2958
Mailing Address - Country:US
Mailing Address - Phone:818-953-5401
Mailing Address - Fax:818-953-2811
Practice Address - Street 1:2031 W ALAMEDA AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2958
Practice Address - Country:US
Practice Address - Phone:818-953-5401
Practice Address - Fax:818-953-2811
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice