Provider Demographics
NPI:1629056361
Name:GITELMAN, JEFFREY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:GITELMAN
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 1:1234 19TH ST NW
Mailing Address - Street 2:SUITE 508
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2407
Mailing Address - Country:US
Mailing Address - Phone:202-223-3391
Mailing Address - Fax:202-833-8874
Practice Address - Street 1:1234 19TH ST NW
Practice Address - Street 2:508
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2407
Practice Address - Country:US
Practice Address - Phone:202-223-3391
Practice Address - Fax:202-833-8874
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC28221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30932Medicare UPIN
DC145927Medicare PIN