Provider Demographics
NPI:1124283197
Name:GERLACH, NOLAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:L
Last Name:GERLACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16604 SE 17TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5125
Mailing Address - Country:US
Mailing Address - Phone:206-854-6317
Mailing Address - Fax:
Practice Address - Street 1:875 140TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3400
Practice Address - Country:US
Practice Address - Phone:425-614-3777
Practice Address - Fax:425-641-1960
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR600324601223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice