Provider Demographics
NPI:1104989847
Name:GELLIN, ROBERT GEOFFREY (DMD, MHS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEOFFREY
Last Name:GELLIN
Suffix:
Gender:M
Credentials:DMD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 ASHLEY AVE
Mailing Address - Street 2:DENTAL FACULTY PRACTICE, BSB ROOM 346
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-0001
Mailing Address - Country:US
Mailing Address - Phone:843-792-3444
Mailing Address - Fax:843-792-0348
Practice Address - Street 1:173 ASHLEY AVE
Practice Address - Street 2:DENTAL FACULTY PRACTICE, BSB ROOM 346
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-3444
Practice Address - Fax:843-792-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27971223G0001X
SC3451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0300XDental ProvidersDentistPeriodontics