Provider Demographics
NPI:1073625620
Name:GERNER, CARL THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:THOMAS
Last Name:GERNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:91 HAMMOND LN
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2000
Mailing Address - Country:US
Mailing Address - Phone:518-563-7620
Mailing Address - Fax:518-563-9151
Practice Address - Street 1:91 HAMMOND LN
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2000
Practice Address - Country:US
Practice Address - Phone:518-563-7620
Practice Address - Fax:518-563-9151
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY035408332B00000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies