Provider Demographics
NPI:1326183138
Name:GELLER, BENJAMIN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PAUL
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 1:1817 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06828-0001
Mailing Address - Country:US
Mailing Address - Phone:203-333-4700
Mailing Address - Fax:203-576-0842
Practice Address - Street 1:1817 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06828-0001
Practice Address - Country:US
Practice Address - Phone:203-333-4700
Practice Address - Fax:203-576-0842
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice