Healthcare Provider Details

I. General information

NPI: 1063436244
Provider Name (Legal Business Name): ANDREW GEARHART DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 S ALABAMA AVE
MONROEVILLE AL
36460-3078
US

IV. Provider business mailing address

1618 S ALABAMA AVE
MONROEVILLE AL
36460-3078
US

V. Phone/Fax

Practice location:
  • Phone: 251-743-3123
  • Fax: 251-575-5965
Mailing address:
  • Phone: 251-743-3123
  • Fax: 251-575-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3757
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: