Provider Demographics
NPI:1528268273
Name:GERACE, WILLIAM LASTON (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LASTON
Last Name:GERACE
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 1:1600 E TUDOR RD
Mailing Address - Street 2:STE C
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1049
Mailing Address - Country:US
Mailing Address - Phone:907-561-6262
Mailing Address - Fax:907-562-0378
Practice Address - Street 1:1600 E TUDOR RD
Practice Address - Street 2:STE C
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1049
Practice Address - Country:US
Practice Address - Phone:907-561-6262
Practice Address - Fax:907-562-0378
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice