Provider Demographics
NPI:1043447014
Name:GERLACH FAMILY DENTISTRY PSC
Entity Type:Organization
Organization Name:GERLACH FAMILY DENTISTRY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-368-5529
Mailing Address - Street 1:210 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1922
Mailing Address - Country:US
Mailing Address - Phone:502-368-5529
Mailing Address - Fax:502-368-9883
Practice Address - Street 1:210 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1922
Practice Address - Country:US
Practice Address - Phone:502-368-5529
Practice Address - Fax:502-368-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty