Provider Demographics
NPI:1053325431
Name:MARSHALL GERSON D.D.S. P.A.
Entity Type:Organization
Organization Name:MARSHALL GERSON D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-256-1778
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-0008
Mailing Address - Country:US
Mailing Address - Phone:856-256-1778
Mailing Address - Fax:856-256-9866
Practice Address - Street 1:4 MONROE AVE.
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028
Practice Address - Country:US
Practice Address - Phone:856-256-1778
Practice Address - Fax:856-256-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD1007661001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty