Provider Demographics
NPI:1811627789
Name:LUTZ, GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13TH ADC, 1ST DENTAL BATTALION/NAVAL DENTAL CENTER CAMP
Mailing Address - Street 2:PENDLETON BLDG. 13128 14TH STREET
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5221
Mailing Address - Country:US
Mailing Address - Phone:573-353-3292
Mailing Address - Fax:
Practice Address - Street 1:13TH ADC, 1ST DENTAL BATTALION/NAVAL DENTAL CENTER CAMP
Practice Address - Street 2:PENDLETON BLDG. 13128 14TH STREET
Practice Address - City:CAMP PENDLETON,
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:573-353-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220197421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice