Gerald S. Convissar DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI01196800 Issued in NJ

Legal business name

GERALD S. CONVISSAR DDS PA

Practice address

2 Rancocas Blvd
Mount Laurel, NJ 08054-2057

Phone

(856) 778-8655

Fax

(856) 231-7480

NPI assigned

Dec 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gerald S Convissar, DDSNPI 1336200518

Title

President

Phone

(856) 778-8655

Specialties & licenses 1

Addresses

Other names 1

• Rancocas Woods Family Dentistry Other name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gerald Steven Convissar, DDS

  • General Practice Dentistry
  • Mount Laurel, NJ
  • NPI 1336200518
  NPD (past) Authorized official
• Brad J Convissar, DMD

  • General Practice Dentistry
  • Mount Laurel, NJ
  • NPI 1316009871
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750443206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1373 HEARTWOOD DR",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080032741",
            "telephone_number": "856-778-8655",
            "fax_number": "856-231-7480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 RANCOCAS BLVD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542057",
            "telephone_number": "856-778-8655",
            "fax_number": "856-231-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERALD S. CONVISSAR DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONVISSAR",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "856-778-8655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01196800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rancocas Woods Family Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Travis James Gehringer, M.D.
• Nicole Olivia Gemignani
• General Medical of NJ Inc
• Katherine Genuino, DPT
• Diane Georgetti, PT
• Gerda & Associates, LLC
• Emilyann C Germanis
• Jason Gerst
• Anushree Ghosh, RN
• Christina Theresa Giambrone

• General Practice Dentistry in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.