Provider Demographics
NPI:1396855847
Name:GEDULD, STEVEN IRWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:IRWIN
Last Name:GEDULD
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 1:73660 CIVIC CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2582
Mailing Address - Country:US
Mailing Address - Phone:760-361-8056
Mailing Address - Fax:760-361-8058
Practice Address - Street 1:73660 CIVIC CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2582
Practice Address - Country:US
Practice Address - Phone:760-361-8056
Practice Address - Fax:760-361-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0329591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA844119OtherUNITED CONCORDIA ID