Provider Demographics
NPI:1326131210
Name:GAERLAN, LOURDES ROBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:ROBERTO
Last Name:GAERLAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice