Provider Demographics
NPI:1407076847
Name:GAISHAUSER, DENNIS A (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:GAISHAUSER
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 1:4087 MEDINA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5946
Mailing Address - Country:US
Mailing Address - Phone:330-725-3736
Mailing Address - Fax:330-725-1896
Practice Address - Street 1:4087 MEDINA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5946
Practice Address - Country:US
Practice Address - Phone:330-725-3736
Practice Address - Fax:330-725-1896
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-85031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice