Provider Demographics
NPI:1225495278
Name:LV DENTAL PLLC
Entity Type:Organization
Organization Name:LV DENTAL PLLC
Other - Org Name:GERLACH & WILLARD DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-964-1855
Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 165
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:972-964-1855
Mailing Address - Fax:972-943-9301
Practice Address - Street 1:5425 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 165
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4236
Practice Address - Country:US
Practice Address - Phone:972-964-1855
Practice Address - Fax:972-943-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15500122300000X
TX27858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty