Provider Demographics
NPI:1043306319
Name:SISSON, GERALD EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EDWARD
Last Name:SISSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9456 CUYAMACA ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5919
Mailing Address - Country:US
Mailing Address - Phone:619-449-0050
Mailing Address - Fax:619-449-0070
Practice Address - Street 1:9456 CUYAMACA ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5919
Practice Address - Country:US
Practice Address - Phone:619-449-0050
Practice Address - Fax:619-449-0070
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist