1710316633 NPI number — ALAN GERBHOLZ, LLC

Table of content: (NPI 1710316633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710316633 NPI number — ALAN GERBHOLZ, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAN GERBHOLZ, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1710316633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27504
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85285-7504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-777-0607
Provider Business Mailing Address Fax Number:
480-777-1345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9227 E LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-5506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-317-2700
Provider Business Practice Location Address Fax Number:
720-344-2663
Provider Enumeration Date:
11/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HAMERSKY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
720-317-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 464158YYHH . This is a "MEDICARE PTAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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