Provider Demographics
NPI:1134278302
Name:GIERA, KELLY M (DDS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:GIERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E BIG BEAVER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1432
Mailing Address - Country:US
Mailing Address - Phone:248-528-2270
Mailing Address - Fax:248-528-2377
Practice Address - Street 1:650 E BIG BEAVER RD
Practice Address - Street 2:SUITE D
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1432
Practice Address - Country:US
Practice Address - Phone:248-528-2270
Practice Address - Fax:248-528-2377
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist