Provider Demographics
NPI:1043237555
Name:GEISER, MICHAEL WARREN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WARREN
Last Name:GEISER
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 1:2233 HAMLINE AVE N
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5002
Mailing Address - Country:US
Mailing Address - Phone:651-633-5087
Mailing Address - Fax:651-633-5148
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:SUITE 111
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5002
Practice Address - Country:US
Practice Address - Phone:651-633-5087
Practice Address - Fax:651-633-5148
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics