Individual
MATTHEW GELALICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1175 HART ST, YUMA, AZ 85365
(928) 269-7135
Mailing address
2058 MAVERICK CIR, LA VERNE, CA 91750-2211
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9941
SC
122300000X
Dentist
Primary
D011625
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1546260662
DOD ID
—
Enumeration date
05/02/2021
Last updated
06/01/2023
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