Provider Demographics
NPI:1699983023
Name:MENOLD, GERALYN M (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALYN
Middle Name:M
Last Name:MENOLD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 SUNSET DR
Mailing Address - Street 2:SUITE B-1B
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5651
Mailing Address - Country:US
Mailing Address - Phone:831-637-1716
Mailing Address - Fax:831-637-1731
Practice Address - Street 1:890 SUNSET DR
Practice Address - Street 2:SUITE B-1B
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5651
Practice Address - Country:US
Practice Address - Phone:831-637-1716
Practice Address - Fax:831-637-1731
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD31596OtherDENTI-CAL
CA141106OtherDENTI-CAL
CAB31596-01OtherDENTI-CAL