Healthcare Provider Details

I. General information

NPI: 1861955643
Provider Name (Legal Business Name): GELLER FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BRONX RIVER RD
BRONXVILLE NY
10708-7013
US

IV. Provider business mailing address

850 BRONX RIVER RD
BRONXVILLE NY
10708-7013
US

V. Phone/Fax

Practice location:
  • Phone: 914-776-1122
  • Fax:
Mailing address:
  • Phone: 914-776-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRIAN DICKERSON
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 951-609-8518