Provider Demographics
NPI:1669454302
Name:GERSTENMAIER, JOHN HERBERT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HERBERT
Last Name:GERSTENMAIER
Suffix:JR
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 1:431 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1225
Mailing Address - Country:US
Mailing Address - Phone:330-867-2474
Mailing Address - Fax:
Practice Address - Street 1:3094 W MARKET ST
Practice Address - Street 2:#260
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3626
Practice Address - Country:US
Practice Address - Phone:330-867-5688
Practice Address - Fax:330-867-9921
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300145371223P0221X
MI29010100571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0273814Medicaid