Healthcare Provider Details

I. General information

NPI: 1588872683
Provider Name (Legal Business Name): ROBERT GELB D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 116TH AVE NE #201
BELLEVUE WA
98004-3804
US

IV. Provider business mailing address

1231 116TH AVE NE #201
BELLEVUE WA
98004-3804
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-1076
  • Fax: 425-646-1046
Mailing address:
  • Phone: 425-455-1076
  • Fax: 425-646-1046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4211
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: