Provider Demographics
NPI:1467576397
Name:GERTSEN, GREGORY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:GERTSEN
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 1:3640 N FEDERAL HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6648
Mailing Address - Country:US
Mailing Address - Phone:954-941-7778
Mailing Address - Fax:954-941-6108
Practice Address - Street 1:3640 N FEDERAL HWY STE 7
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6648
Practice Address - Country:US
Practice Address - Phone:954-941-7778
Practice Address - Fax:954-941-6108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN145761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice