Healthcare Provider Details

I. General information

NPI: 1851441083
Provider Name (Legal Business Name): DMITRY Z GELFAND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 TIOGUE AVENUE
COVENTRY RI
02816
US

IV. Provider business mailing address

903 TIOGUE AVE
COVENTRY RI
02816-6300
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-5864
  • Fax: 401-821-3245
Mailing address:
  • Phone: 401-821-5864
  • Fax: 401-821-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN02853
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: