Provider Demographics
NPI:1134578909
Name:GEHRKE, SHELBY L (RDH)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:L
Other - Last Name:SWERIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2901 W BELTLINE HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3434 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4155
Practice Address - Country:US
Practice Address - Phone:608-443-5482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-12
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002868-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist