Provider Demographics
NPI:1104027895
Name:LOURDES R. GAERLAN, D.M.D., INC.
Entity Type:Organization
Organization Name:LOURDES R. GAERLAN, D.M.D., INC.
Other - Org Name:WINDSMILE FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:GAERLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-421-8190
Mailing Address - Street 1:141 SUNSET AVE
Mailing Address - Street 2:STE. I AND J
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-6347
Mailing Address - Country:US
Mailing Address - Phone:707-421-8190
Mailing Address - Fax:707-421-9145
Practice Address - Street 1:141 SUNSET AVE
Practice Address - Street 2:STE. I AND J
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-6347
Practice Address - Country:US
Practice Address - Phone:707-421-8190
Practice Address - Fax:707-421-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty