Active NPI
Marc Geronimo, DDS
- General Practice Dentistry
- Phoenix, AZ
National Provider Identifier
1255406682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D008545
- Practice address
- 4550 E Thomas Rd
Phoenix, AZ 85018-7610 - Phone
- (602) 281-7072
- NPI assigned
- Nov 21, 2006
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 54258 | CA | |
| General Practice Dentistry | 1223G0001X | D008545 | AZ | Primary |
Addresses
Primary practice location
4550 E Thomas Rd
Phoenix, AZ 85018-7610
Mailing address
2524 E Prescott CT
Gilbert, AZ 85298-2331
Phone (619) 871-2763
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54258 | CA | MD | Dentist |
| D008545 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jerome a Bannister DDS Inc | General Practice | Past | Accepting new patients |
| Michael H. Ho, DDS. Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- San Diego, CA
- NPI 1154310472
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1255406682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2524 E PRESCOTT CT",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852982331",
"telephone_number": "619-871-2763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4550 E THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850187610",
"telephone_number": "602-281-7072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERONIMO",
"first_name": "MARC",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2022-07-21",
"certification_date": "2022-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "54258",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D008545",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.