Individual
DR. GERALD STEVEN CONVISSAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2 RANCOCAS BLVD, MOUNT LAUREL, NJ 08054
(856) 778-8655
(856) 231-7480
Mailing address
1373 HEARTWOOD DRIVE, CHERRY HILL, NJ 08003
(856) 354-1986
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI01196800
NJ
Other
Enumeration date
12/12/2006
Last updated
07/08/2007
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