Provider Demographics
NPI:1366444200
Name:ZELASKO, GERALD FREDRICK (DDS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:FREDRICK
Last Name:ZELASKO
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 1:6455 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1254
Mailing Address - Country:US
Mailing Address - Phone:716-674-6688
Mailing Address - Fax:716-674-6695
Practice Address - Street 1:6455 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1254
Practice Address - Country:US
Practice Address - Phone:716-674-6688
Practice Address - Fax:716-674-6695
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist