Provider Demographics
NPI:1073606380
Name:GESSNER, LARRY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAMES
Last Name:GESSNER
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 1:1919 7TH AVE S STE 524E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2005
Mailing Address - Country:US
Mailing Address - Phone:205-975-0566
Mailing Address - Fax:205-975-6519
Practice Address - Street 1:1919 7TH AVE S STE 524E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2005
Practice Address - Country:US
Practice Address - Phone:205-975-0566
Practice Address - Fax:205-975-6519
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300161431223G0001X
ALD.6783-C1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0397039Medicaid