Healthcare Provider Details

I. General information

NPI: 1679444772
Provider Name (Legal Business Name): RITA GELONECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26021 COOLIDGE HWY
OAK PARK MI
48237-1109
US

IV. Provider business mailing address

850 BOX CANYON CT
ROCHESTER HILLS MI
48309-2328
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-1780
  • Fax:
Mailing address:
  • Phone: 248-547-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602772
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: