Provider Demographics
NPI:1770638207
Name:GHERARDI, ROBERT JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:GHERARDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 EUBANK BLVD NE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3465
Mailing Address - Country:US
Mailing Address - Phone:505-293-6125
Mailing Address - Fax:505-293-6130
Practice Address - Street 1:8310 PALOMAS AVE NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5286
Practice Address - Country:US
Practice Address - Phone:505-293-6125
Practice Address - Fax:505-293-6130
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD 13501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice