Healthcare Provider Details

I. General information

NPI: 1508031642
Provider Name (Legal Business Name): DAVID C GEHRING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-2465
US

IV. Provider business mailing address

5012 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-2465
US

V. Phone/Fax

Practice location:
  • Phone: 319-378-3333
  • Fax: 319-378-3332
Mailing address:
  • Phone: 319-378-3333
  • Fax: 319-378-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7644
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier872922
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerUNITED CONCORDIA
# 2
Identifier51479
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 3
Identifier1124941
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: