Provider Demographics
NPI:1710316633
Name:ALAN GERBHOLZ, LLC
Entity Type:Organization
Organization Name:ALAN GERBHOLZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-317-2700
Mailing Address - Street 1:PO BOX 27504
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-7504
Mailing Address - Country:US
Mailing Address - Phone:480-777-0607
Mailing Address - Fax:480-777-1345
Practice Address - Street 1:9227 E LINCOLN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5506
Practice Address - Country:US
Practice Address - Phone:720-317-2700
Practice Address - Fax:720-344-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO464158YYHHOtherMEDICARE PTAN