Active NPI
Maryse Gellad, D.D.S.
- Dentist
- Granite Bay, CA
National Provider Identifier
1366799793
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61634
- Practice address
- 111 Hamilton CT
Granite Bay, CA 95746-6474 - Phone
- (916) 622-0401
- NPI assigned
- Aug 3, 2012
- Last updated
- Apr 9, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61634 | CA | Primary |
| Dentist | 122300000X | 28717 | TX |
Addresses
Primary practice location
111 Hamilton CT
Granite Bay, CA 95746-6474
Mailing address
111 Hamilton CT
Granite Bay, CA 95746-6474
Phone (916) 622-0401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28717 | TX | MD | Clinical Social Worker |
| 61634 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365465600000",
"number": "1366799793",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 HAMILTON CT",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957466474",
"telephone_number": "916-622-0401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 HAMILTON CT",
"city": "GRANITE BAY",
"state": "CA",
"postal_code": "957466474",
"telephone_number": "916-622-0401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GELLAD",
"first_name": "MARYSE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-03",
"last_updated": "2013-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "61634",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "28717",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite Bay, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.