Healthcare Provider Details

I. General information

NPI: 1013131283
Provider Name (Legal Business Name): JOSEPH A GELERIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N PENNSYLVANIA # 3
GLENDORA CA
91741
US

IV. Provider business mailing address

175 N PENNSYLVANIA # 3
GLENDORA CA
91741
US

V. Phone/Fax

Practice location:
  • Phone: 626-963-7519
  • Fax: 626-335-8212
Mailing address:
  • Phone: 626-963-7519
  • Fax: 626-335-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29871DENTAL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: