Molly Rebecca Gervich, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13489 Issued in MN

Practice address

21343 Archibald Road
Deerwood, MN 56444

Phone

(218) 534-3141

Fax

(218) 534-3949

NPI assigned

Jan 3, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Deerwood Dental, Inc

  dba The Smile Center

  • Clinic/Center
  • Deerwood, MN
  • NPI 1730262585
  NPD (past)
• Northland Smiles Corporation PA

  • Clinic/Center
  • Deerwood, MN
  • NPI 1043567357
  NPD (past)
• Northland Smiles Little Falls, PA

  • Dental Clinic/Center
  • Little Falls, MN
  • NPI 1063972271
  NPD (past)

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555632000000",
    "number": "1861796013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 385",
            "city": "DEERWOOD",
            "state": "MN",
            "postal_code": "56444",
            "telephone_number": "218-534-3141",
            "fax_number": "218-534-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21343 ARCHIBALD ROAD",
            "city": "DEERWOOD",
            "state": "MN",
            "postal_code": "56444",
            "telephone_number": "218-534-3141",
            "fax_number": "218-534-3949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERVICH",
        "first_name": "MOLLY",
        "middle_name": "REBECCA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-03",
        "last_updated": "2019-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6637-15",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08637",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Minnesota Home Care, Inc. (Preferred Care at Home of Central Minnesota)
• Cummings Treasured Time Adult Day Center LLC
• Kendall Lewis Dammeier, DDS
• Rachael Ann Darling
• Deerwood Dental, Inc (The Smile Center)
• Lakes Area Mobile Smiles, Inc (Lakes Mobile Dental)
• Jamie Don Lauwagie, MD
• Minnesota Mobility Systems Inc.
• Shelly A..J. Neiman, CNP
• Northland Smiles Corporation PA

• Dentist in Deerwood, MN
• Providers in Deerwood, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.