Healthcare Provider Details

I. General information

NPI: 1518038942
Provider Name (Legal Business Name): GENE IRWIN GELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0340
US

IV. Provider business mailing address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0340
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-8400
  • Fax:
Mailing address:
  • Phone: 612-625-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7944
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: