Gerald Anthony Verderbar, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901013894 Issued in MI

Practice address

24025 Greater Mack Ave
Suite 201
Saint Clair Shores, MI 48080-1484

Phone

(586) 771-1280

Fax

(586) 771-7396

NPI assigned

Apr 3, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679695621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 MEADOW LN",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482363803",
            "telephone_number": "313-885-1758",
            "fax_number": "586-771-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24025 GREATER MACK AVE",
            "address_2": "SUITE 201",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801484",
            "telephone_number": "586-771-1280",
            "fax_number": "586-771-7396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERDERBAR",
        "first_name": "GERALD",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901013894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• VGW LLC (Park Pharmacy #2)

• General Practice Dentistry in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.