Provider Demographics
NPI:1366799793
Name:GELLAD, MARYSE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARYSE
Middle Name:
Last Name:GELLAD
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 1:111 HAMILTON CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6474
Mailing Address - Country:US
Mailing Address - Phone:916-622-0401
Mailing Address - Fax:
Practice Address - Street 1:111 HAMILTON CT
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6474
Practice Address - Country:US
Practice Address - Phone:916-622-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61634122300000X
TX28717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist