Provider Demographics
NPI:1427022854
Name:GERLACH, ROBERT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:GERLACH
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 1:351 W 6TH STREET
Mailing Address - Street 2:BLDG 440, USA DENTAC
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-767-6735
Mailing Address - Fax:912-767-5425
Practice Address - Street 1:351 W 6TH STREET
Practice Address - Street 2:BLDG 440, USA DENTAC
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-767-6735
Practice Address - Fax:912-767-5425
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6098122300000X, 1223P0300X
MO015647122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist