Healthcare Provider Details

I. General information

NPI: 1538213293
Provider Name (Legal Business Name): MARTIN D. GELENDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 E LIVINGSTON AVE
COLUMBUS OH
43205-2748
US

IV. Provider business mailing address

561 WHITNEY AVE
WORTHINGTON OH
43085-2474
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-3181
  • Fax: 614-252-1549
Mailing address:
  • Phone: 614-252-3181
  • Fax: 614-252-1549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: