Provider Demographics
NPI:1609977941
Name:GERHARD GOORHUIS DDS
Entity Type:Organization
Organization Name:GERHARD GOORHUIS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GERHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOORHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-271-2408
Mailing Address - Street 1:2731 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1814
Mailing Address - Country:US
Mailing Address - Phone:541-271-2408
Mailing Address - Fax:541-271-2408
Practice Address - Street 1:2731 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1814
Practice Address - Country:US
Practice Address - Phone:541-271-2408
Practice Address - Fax:541-271-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD59011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty