MEDICARE: ALFRED RAYMOND GERNERT DMD MS ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3961	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205817145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED RAYMOND GERNERT DMD MS ORTHODONTICS

Provider Business Mailing Address
First Line	:	604 CRYSTAL PLACE
Second Line	:	SUITE 2A
City	:	LAGRANGE
State	:	KY
Zip	:	40031
Country	:	US
Telephone Number	:	502-222-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 CRYSTAL PLACE
Second Line	:	SITE 2A
City	:	LAGRANGE
State	:	KY
Zip	:	40031
Country	:	US
Telephone Number	:	502-222-6202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	08/17/2015

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