Provider Demographics
NPI:1700938909
Name:GERSCH, NICHOLAS J (DDS MS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:GERSCH
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G-5051 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2922
Mailing Address - Country:US
Mailing Address - Phone:810-733-3770
Mailing Address - Fax:810-733-7559
Practice Address - Street 1:G-5051 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2922
Practice Address - Country:US
Practice Address - Phone:810-733-3770
Practice Address - Fax:810-733-7559
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI118061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics