Provider Demographics
NPI:1720187131
Name:JEFFERY GERHARDT DDS PC DENTISTRY
Entity Type:Organization
Organization Name:JEFFERY GERHARDT DDS PC DENTISTRY
Other - Org Name:ADVANCED FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-257-2483
Mailing Address - Street 1:3415A EL SALIDO PKWY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5521
Mailing Address - Country:US
Mailing Address - Phone:512-257-2483
Mailing Address - Fax:512-249-1057
Practice Address - Street 1:3415A EL SALIDO PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5521
Practice Address - Country:US
Practice Address - Phone:512-257-2483
Practice Address - Fax:512-249-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty