Provider Demographics
NPI:1538458385
Name:GERSTEN, ALEXIS (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GERSTEN
Suffix:
Gender:F
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:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0497
Mailing Address - Country:US
Mailing Address - Phone:631-325-0731
Mailing Address - Fax:631-325-5540
Practice Address - Street 1:195 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972
Practice Address - Country:US
Practice Address - Phone:631-325-0731
Practice Address - Fax:631-325-5540
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAGBG78867861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice