Mary Lou Gaerlan DDS Dental Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MARY LOU GAERLAN DDS DENTAL CORP

Practice address

4757 Mangels Blvd
Fairfield, CA 94534-4175

Phone

(707) 864-1010

Fax

(707) 864-8051

NPI assigned

Aug 23, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Donn Manalili

Title

Billing Manager

Phone

(707) 631-5994

Specialties & licenses 1

Addresses

Other names 1

• Windsmile Family Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1225861297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4757 MANGELS BLVD",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945344175",
            "telephone_number": "707-864-1010",
            "fax_number": "707-864-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4757 MANGELS BLVD",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945344175",
            "telephone_number": "707-864-1010",
            "fax_number": "707-864-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY LOU GAERLAN DDS DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-23",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "MANALILI",
        "authorized_official_first_name": "DONN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "707-631-5994",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Windsmile Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizarahy Martinez, LCSW
• Kathy Elaine Martinez
• Natalia Martinez
• Sarah Yvonne Martinez
• Ivette Pilar Maruri, RDH
• Colleen A Masi
• Ian Masiglat
• Joanna Mae Masiglat
• Jaimee Daphne Borja Masilang
• Jose Manuel Mason Sandoval

• General Practice Dentistry in Fairfield, CA
• Providers in Fairfield, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.