1285761551 NPI number — DR. LYNNE S SPENCER GERLACH DDS

Table of content: DR. LYNNE S SPENCER GERLACH DDS (NPI 1285761551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285761551 NPI number — DR. LYNNE S SPENCER GERLACH DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER GERLACH
Provider First Name:
LYNNE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285761551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 COIT RD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75023-5942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-964-1855
Provider Business Mailing Address Fax Number:
972-867-2403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5800 COIT RD
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75023-5942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-964-1855
Provider Business Practice Location Address Fax Number:
972-867-2403
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  15499 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 752403988 . This is a "TAXID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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