Provider Demographics
NPI:1346460391
Name:GEBHARDT, MARY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:GEBHARDT
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 1:700 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038
Mailing Address - Country:US
Mailing Address - Phone:270-388-7645
Mailing Address - Fax:270-388-7645
Practice Address - Street 1:700 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038
Practice Address - Country:US
Practice Address - Phone:270-388-7645
Practice Address - Fax:270-388-7645
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist