Individual
AMANDA GERLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 HULEN ST STE C, FORT WORTH, TX 76107-6885
(817) 476-3503
Mailing address
6454 LIVING PL APT 404, PITTSBURGH, PA 15206-3944
(480) 467-9026
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
13342080-9921
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
36221
TX
Other
Enumeration date
10/05/2020
Last updated
08/23/2023
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