Provider Demographics
NPI:1457906919
Name:GERHARDT, YANA V (DMD)
Entity Type:Individual
Prefix:DR
First Name:YANA
Middle Name:V
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 S 39TH ST UNIT 35
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3828
Mailing Address - Country:US
Mailing Address - Phone:415-235-0816
Mailing Address - Fax:
Practice Address - Street 1:1822 S 39TH ST UNIT 35
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3828
Practice Address - Country:US
Practice Address - Phone:415-235-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist