Provider Demographics
NPI:1376771907
Name:GELFOND, STANISLAV (DDS)
Entity type:Individual
Prefix:
First Name:STANISLAV
Middle Name:
Last Name:GELFOND
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 1:1225 SW STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2545
Mailing Address - Country:US
Mailing Address - Phone:515-964-8350
Mailing Address - Fax:515-964-9515
Practice Address - Street 1:1225 SW STATE ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2545
Practice Address - Country:US
Practice Address - Phone:515-964-8350
Practice Address - Fax:515-964-9515
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice