Provider Demographics
NPI:1457546905
Name:GERAETS, GALEN PHIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:PHIL
Last Name:GERAETS
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 1:1001 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6047
Mailing Address - Country:US
Mailing Address - Phone:970-407-1001
Mailing Address - Fax:
Practice Address - Street 1:1001 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6047
Practice Address - Country:US
Practice Address - Phone:970-407-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist