Provider Demographics
NPI:1952398661
Name:GELDER, NATHAN EUGENE (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:EUGENE
Last Name:GELDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3430
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5028
Mailing Address - Country:US
Mailing Address - Phone:360-683-8884
Mailing Address - Fax:
Practice Address - Street 1:321 N SEQUIM AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3457
Practice Address - Country:US
Practice Address - Phone:360-683-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice