Provider Demographics
NPI:1376684290
Name:GORSEN, MELVYN N (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:N
Last Name:GORSEN
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 E LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4043
Mailing Address - Country:US
Mailing Address - Phone:856-692-4670
Mailing Address - Fax:856-692-3068
Practice Address - Street 1:1017 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4043
Practice Address - Country:US
Practice Address - Phone:856-692-4670
Practice Address - Fax:856-692-3068
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008470001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice