Provider Demographics
NPI:1073520730
Name:MONSERUD, GERALD D (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:D
Last Name:MONSERUD
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 1:418 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:IA
Mailing Address - Zip Code:52358
Mailing Address - Country:US
Mailing Address - Phone:319-643-7170
Mailing Address - Fax:
Practice Address - Street 1:418 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:IA
Practice Address - Zip Code:52358-9706
Practice Address - Country:US
Practice Address - Phone:319-643-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist