Provider Demographics
NPI:1174744726
Name:GELB, SUSANNE M (DDS)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:M
Last Name:GELB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 GILLETT ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2629
Mailing Address - Country:US
Mailing Address - Phone:860-247-5679
Mailing Address - Fax:860-278-1104
Practice Address - Street 1:86 GILLETT ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2629
Practice Address - Country:US
Practice Address - Phone:860-247-5679
Practice Address - Fax:860-278-1104
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice