Basic Information
| Provider Information | |||||||||
| NPI: | 1710316633 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALAN GERBHOLZ, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27504 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852857504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807770607 | ||||||||
| FaxNumber: | 4807771345 | ||||||||
| Practice Location | |||||||||
| Address1: | 9227 E LINCOLN AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203172700 | ||||||||
| FaxNumber: | 7203442663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2013 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | HAMERSKY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 7203172700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 464158YYHH | 01 | CO | MEDICARE PTAN | OTHER |