Healthcare Provider Details

I. General information

NPI: 1144074402
Provider Name (Legal Business Name): EDWARD GELFAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 E OAKLAND PARK BLVD # 310
FORT LAUDERDALE FL
33306-1800
US

IV. Provider business mailing address

2826 E OAKLAND PARK BLVD # 310
FORT LAUDERDALE FL
33306-1800
US

V. Phone/Fax

Practice location:
  • Phone: 954-776-4720
  • Fax:
Mailing address:
  • Phone: 416-565-7467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN28578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: