Provider Demographics
NPI:1730230160
Name:GELDER, SCOTT A (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:GELDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 GLENWAY AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3905
Mailing Address - Country:US
Mailing Address - Phone:513-921-6377
Mailing Address - Fax:
Practice Address - Street 1:4966 GLENWAY AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3905
Practice Address - Country:US
Practice Address - Phone:513-921-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-19796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist