Provider Demographics
NPI:1215333851
Name:GIERLACH, JOHN (BDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GIERLACH
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2003
Mailing Address - Country:US
Mailing Address - Phone:410-255-1050
Mailing Address - Fax:410-255-4442
Practice Address - Street 1:2705 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2003
Practice Address - Country:US
Practice Address - Phone:410-255-1050
Practice Address - Fax:410-255-4442
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist