Provider Demographics
NPI:1508817982
Name:GERARD, AUDREY MARLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:MARLA
Last Name:GERARD
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 1:6399 ROBISON LN
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9248
Mailing Address - Country:US
Mailing Address - Phone:734-944-4501
Mailing Address - Fax:
Practice Address - Street 1:3815 PELHAM ST
Practice Address - Street 2:SUITE 11
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3852
Practice Address - Country:US
Practice Address - Phone:313-565-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0146851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice