Provider Demographics
NPI:1902242936
Name:DEAS, GERTRUDE KATRINA (RDH,,MBA)
Entity Type:Individual
Prefix:MRS
First Name:GERTRUDE
Middle Name:KATRINA
Last Name:DEAS
Suffix:
Gender:F
Credentials:RDH,,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DJ EBONI LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3321
Mailing Address - Country:US
Mailing Address - Phone:843-478-6860
Mailing Address - Fax:
Practice Address - Street 1:111 DJ EBONI LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3321
Practice Address - Country:US
Practice Address - Phone:843-478-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1576124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist