Provider Demographics
NPI:1174624795
Name:GESSLING, RICHARD C
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:GESSLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 567
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068
Mailing Address - Country:US
Mailing Address - Phone:406-446-1010
Mailing Address - Fax:406-446-3858
Practice Address - Street 1:606 S GRANT ST
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068
Practice Address - Country:US
Practice Address - Phone:406-446-1010
Practice Address - Fax:406-446-3858
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT181041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5511706OtherCHIP
MT7160634OtherCHIP