Provider Demographics
NPI:1144392770
Name:GELINNE, SONI RAE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:SONI
Middle Name:RAE
Last Name:GELINNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 IOWA AVE
Mailing Address - Street 2:PO BOX 28
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1631
Mailing Address - Country:US
Mailing Address - Phone:712-433-3937
Mailing Address - Fax:712-433-1493
Practice Address - Street 1:909 IOWA AVE
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1631
Practice Address - Country:US
Practice Address - Phone:712-433-3937
Practice Address - Fax:712-433-1493
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA127420OtherUNITED CONCORDIA
IA1126326Medicaid
IA51890OtherWELLMARK