Provider Demographics
NPI:1376619767
Name:GERARD A VELTRI DDS INC
Entity Type:Organization
Organization Name:GERARD A VELTRI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELTRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-622-8001
Mailing Address - Street 1:222 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2906
Mailing Address - Country:US
Mailing Address - Phone:304-622-8001
Mailing Address - Fax:304-622-0619
Practice Address - Street 1:222 COURT ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2906
Practice Address - Country:US
Practice Address - Phone:304-622-8001
Practice Address - Fax:304-622-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28291223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132535000Medicaid