Healthcare Provider Details

I. General information

NPI: 1184504029
Provider Name (Legal Business Name): GENNA GELFAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 GREAT NORTHERN BLVD
NORTH OLMSTED OH
44070-3427
US

IV. Provider business mailing address

14615 JANE STREET
KING CITY ON
L7B 1A3
CA

V. Phone/Fax

Practice location:
  • Phone: 440-455-1787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: