Healthcare Provider Details

I. General information

NPI: 1881602001
Provider Name (Legal Business Name): MARK STEVEN GELLER D.D.S., M.S.D, P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 COIT RD STE 108
PLANO TX
75075-7757
US

IV. Provider business mailing address

1220 COIT RD STE 108
PLANO TX
75075-7757
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-4502
  • Fax: 972-867-0194
Mailing address:
  • Phone: 972-596-4502
  • Fax: 972-867-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number010045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: