Provider Demographics
NPI:1528232519
Name:ELLIOTT M. GERSON DDS, PC
Entity Type:Organization
Organization Name:ELLIOTT M. GERSON DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDA, OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRENZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-230-3737
Mailing Address - Street 1:67 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1103
Mailing Address - Country:US
Mailing Address - Phone:508-230-3737
Mailing Address - Fax:508-230-3733
Practice Address - Street 1:67 BELMONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1103
Practice Address - Country:US
Practice Address - Phone:508-230-3737
Practice Address - Fax:508-230-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty