Provider Demographics
NPI:1194153551
Name:GERLANTS, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GERLANTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 WOODRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-4276
Mailing Address - Country:US
Mailing Address - Phone:248-978-5999
Mailing Address - Fax:
Practice Address - Street 1:4438 WOODRIDGE CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-4276
Practice Address - Country:US
Practice Address - Phone:248-978-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902014191124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1223390Medicaid