Provider Demographics
NPI:1902842206
Name:GONSMAN, RICHARD ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:GONSMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:ALAN
Other - Last Name:GONSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:320 BLAIR ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1804
Mailing Address - Country:US
Mailing Address - Phone:814-696-3354
Mailing Address - Fax:814-696-0560
Practice Address - Street 1:320 BLAIR ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1804
Practice Address - Country:US
Practice Address - Phone:814-696-3354
Practice Address - Fax:814-696-0560
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0217201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice