Individual
KENNETH GERSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1404 EASTLAND DR, BLOOMINGTON, IL 61701-3532
(309) 663-4711
(309) 663-1854
Mailing address
1404 EASTLAND DR, BLOOMINGTON, IL 61701-3532
(309) 663-4711
(309) 663-1854
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
019014048
IL
1223P0300X
Periodontics
Primary
021001002
IL
Other
Enumeration date
12/21/2006
Last updated
09/23/2009
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