Provider Demographics
NPI:1437285186
Name:GERBHOLZ, ALAN HUGO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:HUGO
Last Name:GERBHOLZ
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 1:10450 PARK MEADOWS DR
Mailing Address - Street 2:STE 102
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5529
Mailing Address - Country:US
Mailing Address - Phone:303-910-8176
Mailing Address - Fax:
Practice Address - Street 1:3940 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3468
Practice Address - Country:US
Practice Address - Phone:972-227-6453
Practice Address - Fax:972-780-9167
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TX334881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6965170001Medicare NSC