Provider Demographics
NPI:1043213036
Name:GELLE, GERALD G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:G
Last Name:GELLE
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 1:2042 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4211
Mailing Address - Country:US
Mailing Address - Phone:510-523-1995
Mailing Address - Fax:510-523-6155
Practice Address - Street 1:2042 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4211
Practice Address - Country:US
Practice Address - Phone:510-523-1995
Practice Address - Fax:510-523-6155
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist