Provider Demographics
NPI:1023389905
Name:GERSON, REBEKKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBEKKA
Middle Name:
Last Name:GERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 GERSON DR
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1232
Mailing Address - Country:US
Mailing Address - Phone:215-779-7847
Mailing Address - Fax:
Practice Address - Street 1:3048 BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2107
Practice Address - Country:US
Practice Address - Phone:610-825-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO363331223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics