Healthcare Provider Details

I. General information

NPI: 1205120425
Provider Name (Legal Business Name): MATTHEW GELLERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 05/31/2020
Certification Date: 05/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5462 SHERIDAN DR
WILLIAMSVILLE NY
14221-3702
US

IV. Provider business mailing address

4330 MAPLE RD
AMHERST NY
14226-1064
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-8018
  • Fax:
Mailing address:
  • Phone: 716-362-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number056050
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: