Healthcare Provider Details

I. General information

NPI: 1174624795
Provider Name (Legal Business Name): RICHARD C GESSLING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S GRANT ST
RED LODGE MT
59068
US

IV. Provider business mailing address

P.O. BOX 567
RED LODGE MT
59068
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-1010
  • Fax: 406-446-3858
Mailing address:
  • Phone: 406-446-1010
  • Fax: 406-446-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18104
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: