Healthcare Provider Details

I. General information

NPI: 1427022854
Provider Name (Legal Business Name): ROBERT C GERLACH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W 6TH STREET BLDG 440, USA DENTAC
FT STEWART GA
31314
US

IV. Provider business mailing address

351 W 6TH STREET BLDG 440, USA DENTAC
FT STEWART GA
31314
US

V. Phone/Fax

Practice location:
  • Phone: 912-767-6735
  • Fax: 912-767-5425
Mailing address:
  • Phone: 912-767-6735
  • Fax: 912-767-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6098
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number015647
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6098
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number015647
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: