Provider Demographics
NPI:1194760330
Name:ELPERT, GERALD A (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:ELPERT
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 1:622 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-1956
Mailing Address - Country:US
Mailing Address - Phone:605-256-6668
Mailing Address - Fax:605-256-9251
Practice Address - Street 1:622 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-1956
Practice Address - Country:US
Practice Address - Phone:605-256-6668
Practice Address - Fax:605-256-9251
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7800870Medicaid
SD550231Medicare ID - Type UnspecifiedMEDICARE PROVIDER #