Provider Demographics
NPI:1114074572
Name:GELLER, NICHOLAS S (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:S
Last Name:GELLER
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 1:1905 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2883
Mailing Address - Country:US
Mailing Address - Phone:651-686-6800
Mailing Address - Fax:651-686-6800
Practice Address - Street 1:1905 PLAZA DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2883
Practice Address - Country:US
Practice Address - Phone:651-686-6800
Practice Address - Fax:651-686-7800
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist