Provider Demographics
NPI:1225161342
Name:GELLAD, SAMER RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:RAYMOND
Last Name:GELLAD
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 1:111 HAMILTON CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6474
Mailing Address - Country:US
Mailing Address - Phone:916-772-0771
Mailing Address - Fax:
Practice Address - Street 1:727 COLUSA AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3943
Practice Address - Country:US
Practice Address - Phone:530-751-0300
Practice Address - Fax:530-751-0331
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist