Provider Demographics
NPI:1093922692
Name:GEAMAN, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:GEAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N GIBBONS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6510
Mailing Address - Country:US
Mailing Address - Phone:847-253-4655
Mailing Address - Fax:
Practice Address - Street 1:676 N MICHIGAN AVE
Practice Address - Street 2:SUITE 3500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2883
Practice Address - Country:US
Practice Address - Phone:312-274-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0169301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice