Provider Demographics
NPI:1104957364
Name:EHNI, GERLINDE (DDS)
Entity type:Individual
Prefix:DR
First Name:GERLINDE
Middle Name:
Last Name:EHNI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-1990
Mailing Address - Country:US
Mailing Address - Phone:970-264-2588
Mailing Address - Fax:970-264-2299
Practice Address - Street 1:703 SAN JUAN ST., STE. 207
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-264-2588
Practice Address - Fax:970-264-2299
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1056751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02056752Medicaid
CO105675OtherSTATE LICENSE