Active NPI
Timothy F Geraci, D.D.S.
- Periodontics
- Oakland, CA
National Provider Identifier
1669675021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 23101
- Practice address
- 3300 Webster St
Suite 905
Oakland, CA 94609-3117 - Phone
- (510) 465-4060
- Fax
- (510) 465-4395
- NPI assigned
- Jun 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 23101 | CA | Primary |
Addresses
Primary practice location
3300 Webster St
Suite 905
Oakland, CA 94609-3117
Mailing address
3300 Webster St
Suite 905
Oakland, CA 94609-3117
Phone (510) 465-4060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94-2236630 | Other | CA | TAX IDENTIFICATION NUMBER |
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 |
|---|---|---|---|
| 23101 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385424000000",
"number": "1669675021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 WEBSTER ST",
"address_2": "SUITE 905",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093117",
"telephone_number": "510-465-4060",
"fax_number": "510-465-4395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 WEBSTER ST",
"address_2": "SUITE 905",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946093117",
"telephone_number": "510-465-4060",
"fax_number": "510-465-4395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERACI",
"first_name": "TIMOTHY",
"middle_name": "F",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-06",
"last_updated": "2013-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "23101",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION NUMBER",
"identifier": "94-2236630",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.