Provider Demographics
NPI:1114997160
Name:GERHARDT, PAUL WILBUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILBUR
Last Name:GERHARDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 LINKENHOLT DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8821
Mailing Address - Country:US
Mailing Address - Phone:901-850-8564
Mailing Address - Fax:
Practice Address - Street 1:763 WALNUT KNOLL LN STE 1
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8858
Practice Address - Country:US
Practice Address - Phone:901-758-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000084861223G0001X
MO0138431223G0001X
VA04010081501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice