Provider Demographics
NPI:1427257419
Name:KERSTETTER, GARY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:KERSTETTER
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 1:41311 YUBA CIR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1546
Mailing Address - Country:US
Mailing Address - Phone:951-308-1108
Mailing Address - Fax:
Practice Address - Street 1:5TH & WESTERN
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860
Practice Address - Country:US
Practice Address - Phone:951-273-2938
Practice Address - Fax:951-273-2326
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist