Provider Demographics
NPI:1962591099
Name:GISSENDANER, ELAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:GISSENDANER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 NORTH ST E
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2188
Mailing Address - Country:US
Mailing Address - Phone:256-362-6861
Mailing Address - Fax:256-362-0932
Practice Address - Street 1:129 NORTH ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2188
Practice Address - Country:US
Practice Address - Phone:256-362-6861
Practice Address - Fax:256-362-0932
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice