Active NPI
Kenneth Gerstein, DDS
- Periodontics
- Bloomington, IL
National Provider Identifier
1730243056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 021001002
- Practice address
- 1404 Eastland Dr
Bloomington, IL 61701-3532 - Phone
- (309) 663-4711
- Fax
- (309) 663-1854
- NPI assigned
- Dec 21, 2006
- Last updated
- Sep 23, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 019014048 | IL | |
| Periodontics | 1223P0300X | 021001002 | IL | Primary |
Addresses
Primary practice location
1404 Eastland Dr
Bloomington, IL 61701-3532
Mailing address
1404 Eastland Dr
Bloomington, IL 61701-3532
Phone (309) 663-4711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019014048 | IL | MD | Periodontist |
| 021001002 | IL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253664000000",
"number": "1730243056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1404 EASTLAND DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013532",
"telephone_number": "309-663-4711",
"fax_number": "309-663-1854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1404 EASTLAND DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013532",
"telephone_number": "309-663-4711",
"fax_number": "309-663-1854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERSTEIN",
"first_name": "KENNETH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2009-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "019014048",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "021001002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
- Rita M George, DMD
- Brooke Geraty, PT, ATC
- Lauren Carson Gerdes
- Sarah Jean German, PT
- Kristin Gernant
- Krista Getz, DPM
- Kathleen Giacomelli
- Jennifer Gibb, APN
- Gibson Community Hospital Association (Gibson Area Hospital Pain Clinic)
- Gibson Community Hospital Association (Gibson Area Hospital Therapy Services of Bloomington)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.