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General NPI Number Information
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NPI Number | 1053325431
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Entity Type | Organization
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Legal Business Name | MARSHALL GERSON D.D.S. P.A.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 4 MONROE AVE.
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City | GLASSBORO
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State | NJ
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Zip | 08028
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Country | US
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Telephone | 856-256-1778
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Fax | 856-256-9866
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Provider Business Mailing Address
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Address Line | PO BOX 8
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City | GLASSBORO
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State | NJ
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Zip | 08028-0008
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Country | US
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Telephone | 856-256-1778
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Fax | 856-256-9866
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Authorized Official
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Title or Position | PRES.
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Name | DR. MARSHALL GERSON
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Credential | D.D.S.
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Telephone | 856-256-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D100766100
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License Number State | NJ
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