Provider Demographics
NPI:1851441083
Name:GELFAND, DMITRY Z (DDS)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:Z
Last Name:GELFAND
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 1:903 TIOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6300
Mailing Address - Country:US
Mailing Address - Phone:401-821-5864
Mailing Address - Fax:401-821-3245
Practice Address - Street 1:903 TIOGUE AVENUE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-821-5864
Practice Address - Fax:401-821-3245
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN028531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice