Provider Demographics
NPI:1396869673
Name:GERLOFF, ROGER H (DDS)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:H
Last Name:GERLOFF
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:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-0410
Mailing Address - Country:US
Mailing Address - Phone:763-972-2915
Mailing Address - Fax:763-972-3975
Practice Address - Street 1:125 2ND ST N
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8270
Practice Address - Country:US
Practice Address - Phone:763-972-2915
Practice Address - Fax:763-972-3975
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN68621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice