Provider Demographics
NPI:1598820938
Name:GERSHFELD, ROGER GREGORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GREGORY
Last Name:GERSHFELD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7063 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7509
Mailing Address - Country:US
Mailing Address - Phone:323-962-9707
Mailing Address - Fax:323-962-9717
Practice Address - Street 1:7063 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7509
Practice Address - Country:US
Practice Address - Phone:323-962-9707
Practice Address - Fax:323-962-9717
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92918-01OtherDENTI-CAL