Provider Demographics
NPI:1487744207
Name:GERHARDT, JEFFERY WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:WAYNE
Last Name:GERHARDT
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 1:3415 EL SALIDO PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5521
Mailing Address - Country:US
Mailing Address - Phone:512-257-2483
Mailing Address - Fax:
Practice Address - Street 1:3415 EL SALIDO PKWY STE A
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5521
Practice Address - Country:US
Practice Address - Phone:512-257-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist