Provider Demographics
NPI:1871541755
Name:MARTINCICH, GERALD LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEE
Last Name:MARTINCICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:MARTINCICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,, PA
Mailing Address - Street 1:7301 MISSION RD
Mailing Address - Street 2:#233
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3006
Mailing Address - Country:US
Mailing Address - Phone:913-648-6486
Mailing Address - Fax:913-648-3875
Practice Address - Street 1:7301 MISSION RD
Practice Address - Street 2:#233
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3006
Practice Address - Country:US
Practice Address - Phone:913-648-6486
Practice Address - Fax:913-648-3875
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS49521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice