Provider Demographics
NPI:1255386140
Name:GISSELL, MICHAEL B JR (DDS MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:GISSELL
Suffix:JR
Gender:M
Credentials:DDS MD
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Mailing Address - Street 1:6501 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216
Mailing Address - Country:US
Mailing Address - Phone:210-341-7264
Mailing Address - Fax:210-341-2022
Practice Address - Street 1:6501 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-341-7264
Practice Address - Fax:210-341-2022
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX200871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery