Provider Demographics
NPI:1588176440
Name:EDWARD S. GERODIAS, DMD. INC.
Entity type:Organization
Organization Name:EDWARD S. GERODIAS, DMD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERODIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:209-526-4244
Mailing Address - Street 1:220 STANDIFORD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1159
Mailing Address - Country:US
Mailing Address - Phone:209-526-4244
Mailing Address - Fax:209-526-0112
Practice Address - Street 1:220 STANDIFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1159
Practice Address - Country:US
Practice Address - Phone:209-526-4244
Practice Address - Fax:209-526-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46799261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental