Provider Demographics
NPI:1134537277
Name:GAERTNER, ADELHEID THERESA
Entity type:Individual
Prefix:MRS
First Name:ADELHEID
Middle Name:THERESA
Last Name:GAERTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:THERESA
Other - Last Name:GAERTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:210 NW BARSTOW ST
Mailing Address - Street 2:305
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-522-7645
Mailing Address - Fax:262-522-2828
Practice Address - Street 1:210 NW BARSTOW ST
Practice Address - Street 2:305
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3771
Practice Address - Country:US
Practice Address - Phone:262-522-7645
Practice Address - Fax:262-522-2828
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3268-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist