Healthcare Provider Details

I. General information

NPI: 1770704736
Provider Name (Legal Business Name): JOHN GELL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 BRIDGEPORT AVE
SHELTON CT
06484-3844
US

IV. Provider business mailing address

375 BRIDGEPORT AVE
SHELTON CT
06484-3844
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-2121
  • Fax:
Mailing address:
  • Phone: 203-929-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4468
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: