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General NPI Number Information
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NPI Number | 1619504164
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Entity Type | Individual
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Provider Name | ANNA NICOLE GERLACH DMD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 1915 NE BAKER ST
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City | MCMINNVILLE
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State | OR
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Zip | 97128-2601
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Country | US
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Telephone | 503-472-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 10500 SW BANNOCH CT
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City | TUALATIN
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State | OR
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Zip | 97062-8400
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Country | US
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Telephone | 503-319-0541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11212
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License Number State | OR
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