Provider Demographics
NPI:1962493726
Name:GERLACH, HAROLD VERNON (DMD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:VERNON
Last Name:GERLACH
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 1:210 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-1922
Mailing Address - Country:US
Mailing Address - Phone:502-368-5529
Mailing Address - Fax:502-368-5529
Practice Address - Street 1:210 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-1922
Practice Address - Country:US
Practice Address - Phone:502-368-5529
Practice Address - Fax:502-368-5529
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5353FEPY710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
60053535Medicare ID - Type Unspecified