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General NPI Number Information
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NPI Number | 1912394867
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Entity Type | Organization
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Legal Business Name | STEPHEN J GERSHBERG DMD PC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 14 S BRYN MAWR AVE SUITE #200
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City | BRYN MAWR
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State | PA
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Zip | 19010-3216
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Country | US
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Telephone | 610-527-6700
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Fax | 484-383-3176
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Provider Business Mailing Address
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Address Line | 14 S BRYN MAWR AVE SUITE #200
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City | BRYN MAWR
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State | PA
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Zip | 19010-3216
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Country | US
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Telephone | 610-527-6700
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Fax | 484-383-3176
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN GERSHBERG
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Credential | DMD
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Telephone | 610-527-6700
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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 | DS-023427L
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License Number State | PA
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