Healthcare Provider Details

I. General information

NPI: 1396869673
Provider Name (Legal Business Name): ROGER H GERLOFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 2ND ST N
DELANO MN
55328-8270
US

IV. Provider business mailing address

PO BOX 410
DELANO MN
55328-0410
US

V. Phone/Fax

Practice location:
  • Phone: 763-972-2915
  • Fax: 763-972-3975
Mailing address:
  • Phone: 763-972-2915
  • Fax: 763-972-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6862
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: