Provider Demographics
NPI:1609998962
Name:GERARDOT, AMY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:GERARDOT
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 1:11691 KITTERY DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7858
Mailing Address - Country:US
Mailing Address - Phone:317-578-2429
Mailing Address - Fax:
Practice Address - Street 1:3909 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-1769
Practice Address - Country:US
Practice Address - Phone:765-288-1475
Practice Address - Fax:765-289-3584
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010345A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist