Healthcare Provider Details

I. General information

NPI: 1285769794
Provider Name (Legal Business Name): RICHARD GELDER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19240 QUESADA AVE
PORT CHARLOTTE FL
33948-3126
US

IV. Provider business mailing address

19240 QUESADA AVE
PORT CHARLOTTE FL
33948-3126
US

V. Phone/Fax

Practice location:
  • Phone: 941-743-7435
  • Fax: 941-743-7429
Mailing address:
  • Phone: 941-743-7435
  • Fax: 941-743-7429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: