Provider Demographics
NPI:1376634030
Name:BINDER, GERALD MELVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MELVIN
Last Name:BINDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:MELVIN
Other - Last Name:BINDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111
Mailing Address - Country:US
Mailing Address - Phone:509-397-2951
Mailing Address - Fax:509-397-6772
Practice Address - Street 1:204 S MAIN
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111
Practice Address - Country:US
Practice Address - Phone:509-397-2951
Practice Address - Fax:509-397-6772
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5222WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
5501OtherWASHINGTON DENTAL SERVICE
WA82214OtherDEPT LABOR & INDUSTRIES
WA5550108OtherMEDICAID DSHS