Healthcare Provider Details

I. General information

NPI: 1912006438
Provider Name (Legal Business Name): THOMAS E GELHAUS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N16408 COUNTY ROAD D
OWEN WI
54460-9332
US

IV. Provider business mailing address

N16408 COUNTY ROAD D
OWEN WI
54460-9332
US

V. Phone/Fax

Practice location:
  • Phone: 715-229-2827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3342
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: