Healthcare Provider Details

I. General information

NPI: 1316036767
Provider Name (Legal Business Name): JULIE A GELNETT D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BARLOWS LANDING RD UNIT 20
POCASSET MA
02559-1980
US

IV. Provider business mailing address

4 BARLOWS LANDING RD UNIT 20
POCASSET MA
02559-1980
US

V. Phone/Fax

Practice location:
  • Phone: 508-564-7570
  • Fax: 508-564-7571
Mailing address:
  • Phone: 508-564-7570
  • Fax: 508-564-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20325
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: