Healthcare Provider Details

I. General information

NPI: 1982690434
Provider Name (Legal Business Name): LAURENCE ROBERT GERBO D.D.S., M.P.H., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AV. DE SAVOIE SERVICE DENTAIRE SCOLAIRE
LAUSANNE VAUD
1003
CH

IV. Provider business mailing address

2 AV. DE SAVOIE SERVICE DENTAIRE SCOLAIRE
LAUSANNE VAUD
1003
CH

V. Phone/Fax

Practice location:
  • Phone: 0041213156701
  • Fax: 0041213156700
Mailing address:
  • Phone: 0041213156701
  • Fax: 0041213156700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4027
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: