Healthcare Provider Details

I. General information

NPI: 1770668782
Provider Name (Legal Business Name): GERALD M KORSTEN DDS PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 NE CHIPMAN RD
LEES SUMMIT MO
64063
US

IV. Provider business mailing address

248 NE CHIPMAN RD
LEES SUMMIT MO
64063
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-4144
  • Fax: 816-246-9773
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12186
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: