1871541755 NPI number — DR. GERALD LEE MARTINCICH D.D.S.

Table of content: DR. GERALD LEE MARTINCICH D.D.S. (NPI 1871541755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871541755 NPI number — DR. GERALD LEE MARTINCICH D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINCICH
Provider First Name:
GERALD
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINCICH
Provider Other First Name:
JERRY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S,, P.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871541755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 MISSION RD
Provider Second Line Business Mailing Address:
#233
Provider Business Mailing Address City Name:
PRAIRIE VILLAGE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66208-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-648-6486
Provider Business Mailing Address Fax Number:
913-648-3875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 MISSION RD
Provider Second Line Business Practice Location Address:
#233
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66208-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-648-6486
Provider Business Practice Location Address Fax Number:
913-648-3875
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4952 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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