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NPI Code Detail

MEDICARE: DR. AMELIA MIKKONEN GERLACH DDS

MEDICARE: DR. AMELIA MIKKONEN GERLACH DDS
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
11223G0001XGeneral Practice DentistryD11653MN

Other Identifiers

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

General Provider Information

NPI Number : 1215096862
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMELIA MIKKONEN GERLACH DDS
Provider Business Mailing Address
First Line : 5809 91ST CRES N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1620
Country : US
Telephone Number : 763-424-7292
Fax Number :
Provider Business Practice Location Address
First Line : 6437 BROOKLYN BLVD
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55429-2174
Country : US
Telephone Number : 763-531-7177
Fax Number : 763-535-6284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 07/08/2007

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