Provider Demographics
NPI:1972557999
Name:GELDER, BRET D (DDS,MD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:D
Last Name:GELDER
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2410
Mailing Address - Country:US
Mailing Address - Phone:518-374-9109
Mailing Address - Fax:518-374-1978
Practice Address - Street 1:1070 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2410
Practice Address - Country:US
Practice Address - Phone:518-374-9109
Practice Address - Fax:518-374-1978
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0475931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9175734OtherDORAL DENTAL
NY1007-4714OtherCDPHP
NY02624431Medicaid
NY9175734OtherDORAL DENTAL