Provider Demographics
NPI:1093490872
Name:GERHARDT, ABAGAIL MAE (DDS)
Entity Type:Individual
Prefix:
First Name:ABAGAIL
Middle Name:MAE
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NW BEECHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1166
Mailing Address - Country:US
Mailing Address - Phone:515-975-5389
Mailing Address - Fax:
Practice Address - Street 1:2575 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1718
Practice Address - Country:US
Practice Address - Phone:515-200-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist