Provider Demographics
NPI:1518296987
Name:AGSA
Entity Type:Organization
Organization Name:AGSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:GERBHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-810-9176
Mailing Address - Street 1:850 W HAPPY CANYON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3908
Mailing Address - Country:US
Mailing Address - Phone:303-688-5705
Mailing Address - Fax:303-688-5731
Practice Address - Street 1:850 W HAPPY CANYON RD
Practice Address - Street 2:SUITE B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3908
Practice Address - Country:US
Practice Address - Phone:303-688-5705
Practice Address - Fax:303-688-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty