Healthcare Provider Details

I. General information

NPI: 1467646349
Provider Name (Legal Business Name): JARED ADAM GELLER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL POSTGRADUATE DENTAL SCHOOL 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

NAVAL POSTGRADUATE DENTAL SCHOOL 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0145
  • Fax:
Mailing address:
  • Phone: 301-295-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21896
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: