Healthcare Provider Details

I. General information

NPI: 1285822593
Provider Name (Legal Business Name): ZOLYA GELLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SILVER SPRING DR STE 320
MILWAUKEE WI
53217-5059
US

IV. Provider business mailing address

200 W SILVER SPRING DR STE 320
MILWAUKEE WI
53217-5059
US

V. Phone/Fax

Practice location:
  • Phone: 414-332-1808
  • Fax: 414-332-5640
Mailing address:
  • Phone: 414-332-1808
  • Fax: 414-332-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberWI 3090
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: