Provider Demographics
NPI:1184684615
Name:JOSEPHSON, GERALD MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MARC
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 CENTRE AVE
Mailing Address - Street 2:SUITE 800C
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3780
Mailing Address - Country:US
Mailing Address - Phone:412-361-7300
Mailing Address - Fax:412-361-4857
Practice Address - Street 1:13401 SUMMERLIN RD STE 8
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-6593
Practice Address - Country:US
Practice Address - Phone:239-415-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019130L1223G0001X
FLDN7364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice