Healthcare Provider Details

I. General information

NPI: 1922355296
Provider Name (Legal Business Name): JOSEPH L GELO III D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6252 S RAINBOW BLVD STE 130
LAS VEGAS NV
89118-3249
US

IV. Provider business mailing address

6252 S RAINBOW BLVD STE 130
LAS VEGAS NV
89118-3249
US

V. Phone/Fax

Practice location:
  • Phone: 702-734-6252
  • Fax: 702-257-6259
Mailing address:
  • Phone: 702-734-6252
  • Fax: 702-257-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6252
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: