Healthcare Provider Details

I. General information

NPI: 1033147905
Provider Name (Legal Business Name): JOHN HENRY WINSTEN GELLES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER 3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

7982 AMARGOSA DR
CARLSBAD CA
92009-9103
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-7525
  • Fax: 858-552-7507
Mailing address:
  • Phone: 760-942-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12568
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number50865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: