Provider Demographics
NPI:1780775593
Name:GERSTEIN, LAWRENCE MARK (DDS)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MARK
Last Name:GERSTEIN
Suffix:
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 1:3830 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-4107
Mailing Address - Country:US
Mailing Address - Phone:313-383-6800
Mailing Address - Fax:313-383-1026
Practice Address - Street 1:3830 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-4107
Practice Address - Country:US
Practice Address - Phone:313-383-6800
Practice Address - Fax:313-383-1026
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI102221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice