Provider Demographics
NPI:1174614168
Name:KAZMERSKI, GERALD J (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:KAZMERSKI
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:SCRANTON PRIMARY HEALTH CARE CENTER-DENTAL
Mailing Address - Street 2:959 WYOMING AVENUE, SECOND FLOOR
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509
Mailing Address - Country:US
Mailing Address - Phone:570-504-0882
Mailing Address - Fax:570-504-0859
Practice Address - Street 1:959 WYOMING AVE
Practice Address - Street 2:SECOND FLOOR, DENTAL OFFICES
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-3023
Practice Address - Country:US
Practice Address - Phone:570-504-0882
Practice Address - Fax:570-504-0859
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017739L1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010505830003Medicaid