Provider Demographics
NPI:1639486913
Name:GERSHBERG, STEPHEN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:GERSHBERG
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 1:14 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3216
Mailing Address - Country:US
Mailing Address - Phone:610-527-6700
Mailing Address - Fax:610-527-6704
Practice Address - Street 1:14 S BRYN MAWR AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3216
Practice Address - Country:US
Practice Address - Phone:610-527-6700
Practice Address - Fax:610-527-6704
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023427L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice