Provider Demographics
NPI:1619048493
Name:GERSTENBERG, BRYAN IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:IAN
Last Name:GERSTENBERG
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 1:905 GARDEN GATE CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8629
Mailing Address - Country:US
Mailing Address - Phone:850-477-8668
Mailing Address - Fax:850-477-0449
Practice Address - Street 1:905 GARDEN GATE CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8629
Practice Address - Country:US
Practice Address - Phone:850-477-8668
Practice Address - Fax:850-477-0449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN137321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice