Provider Demographics
NPI:1972816460
Name:NOLAN L. GERLACH D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:NOLAN L. GERLACH D.D.S., P.L.L.C.
Other - Org Name:BELLEVUE PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-854-6317
Mailing Address - Street 1:16604 SE 17TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5125
Mailing Address - Country:US
Mailing Address - Phone:206-854-6317
Mailing Address - Fax:
Practice Address - Street 1:875 140TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3400
Practice Address - Country:US
Practice Address - Phone:425-614-3777
Practice Address - Fax:425-641-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60130018261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental