Provider Demographics
NPI:1255931408
Name:JOSEPH A. GELERIS
Entity type:Organization
Organization Name:JOSEPH A. GELERIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GELERIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-963-7519
Mailing Address - Street 1:132 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-5315
Mailing Address - Country:US
Mailing Address - Phone:626-963-7519
Mailing Address - Fax:
Practice Address - Street 1:132 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-5315
Practice Address - Country:US
Practice Address - Phone:626-963-7519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery