Provider Demographics
NPI:1184763641
Name:GESELL, HENRY O (DDS PC)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:O
Last Name:GESELL
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23219 MARTER RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:586-779-2600
Mailing Address - Fax:586-779-2600
Practice Address - Street 1:23219 MARTER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080
Practice Address - Country:US
Practice Address - Phone:586-779-2600
Practice Address - Fax:586-779-2600
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist