Provider Demographics
NPI:1770641920
Name:GERKING, DUANE EDWARD
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:EDWARD
Last Name:GERKING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ED
Other - Middle Name:
Other - Last Name:GERKING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:671 NEWCASTLE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWCASTLE
Mailing Address - State:CA
Mailing Address - Zip Code:95658
Mailing Address - Country:US
Mailing Address - Phone:916-663-3374
Mailing Address - Fax:916-663-9448
Practice Address - Street 1:671 NEWCASTLE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWCASTLE
Practice Address - State:CA
Practice Address - Zip Code:95658
Practice Address - Country:US
Practice Address - Phone:916-663-3374
Practice Address - Fax:916-663-9448
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2728401Medicaid