Healthcare Provider Details

I. General information

NPI: 1104989847
Provider Name (Legal Business Name): ROBERT GEOFFREY GELLIN D.M.D., M.H.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 ASHLEY AVE DENTAL FACULTY PRACTICE, BSB ROOM 346
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

173 ASHLEY AVE DENTAL FACULTY PRACTICE, BSB ROOM 346
CHARLESTON SC
29425-0001
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3444
  • Fax: 843-792-0348
Mailing address:
  • Phone: 843-792-3444
  • Fax: 843-792-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2797
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number345
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: