Healthcare Provider Details

I. General information

NPI: 1730768052
Provider Name (Legal Business Name): MARK STUART GELTZER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17560 NW 27TH AVE
MIAMI GARDENS FL
33056-4014
US

IV. Provider business mailing address

8200 PONCE DE LEON RD
MIAMI FL
33143-8621
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-5157
  • Fax:
Mailing address:
  • Phone: 786-487-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN13775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: