Provider Demographics
NPI:1285822593
Name:GELLER, ZOLYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZOLYA
Middle Name:
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 1:200 W SILVER SPRING DR STE 320
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5059
Mailing Address - Country:US
Mailing Address - Phone:414-332-1808
Mailing Address - Fax:414-332-5640
Practice Address - Street 1:200 W SILVER SPRING DR STE 320
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-5059
Practice Address - Country:US
Practice Address - Phone:414-332-1808
Practice Address - Fax:414-332-5640
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 3090122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist