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General NPI Number Information
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NPI Number | 1669454302
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Entity Type | Individual
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Provider Name | JOHN HERBERT GERSTENMAIER JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3094 W MARKET ST #260
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City | FAIRLAWN
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State | OH
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Zip | 44333-3626
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Country | US
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Telephone | 330-867-5688
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Fax | 330-867-9921
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Provider Business Mailing Address
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Address Line | 431 SAINT ANDREWS DR
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City | AKRON
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State | OH
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Zip | 44303-1225
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Country | US
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Telephone | 330-867-2474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30014537
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901010057
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License Number State | MI
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