Provider Demographics
NPI:1861690984
Name:GUNSELMAN, JOHN WALLACE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALLACE
Last Name:GUNSELMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 DENISON PKWY E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2813
Mailing Address - Country:US
Mailing Address - Phone:607-937-5341
Mailing Address - Fax:607-937-5344
Practice Address - Street 1:218 DENISON PKWY E
Practice Address - Street 2:SUITE 201
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2813
Practice Address - Country:US
Practice Address - Phone:607-937-5341
Practice Address - Fax:607-937-5344
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0313151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice