Healthcare Provider Details

I. General information

NPI: 1538267711
Provider Name (Legal Business Name): HERBERT D GEARHART D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 N 3RD ST
GRAND JUNCTION CO
81501-7503
US

IV. Provider business mailing address

1317 N 3RD ST
GRAND JUNCTION CO
81501-7503
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-2430
  • Fax: 970-248-5432
Mailing address:
  • Phone: 970-241-2430
  • Fax: 970-248-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number358
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: