Provider Demographics
NPI:1538289103
Name:GELDART, GREGORY W (DMD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:W
Last Name:GELDART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17340 PICKWICK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132
Mailing Address - Country:US
Mailing Address - Phone:540-338-3186
Mailing Address - Fax:540-338-3759
Practice Address - Street 1:46400 BENEDICT DR
Practice Address - Street 2:SUITE 205
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6604
Practice Address - Country:US
Practice Address - Phone:703-430-6432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010067641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice