Provider Demographics
NPI:1225130180
Name:GEISSBERGER, JEFFREY LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LOUIS
Last Name:GEISSBERGER
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 1:1341 S ELISEO DR
Mailing Address - Street 2:SUITE 327
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2000
Mailing Address - Country:US
Mailing Address - Phone:415-461-1341
Mailing Address - Fax:415-461-4764
Practice Address - Street 1:1341 S ELISEO DR
Practice Address - Street 2:SUITE 327
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2000
Practice Address - Country:US
Practice Address - Phone:415-461-1341
Practice Address - Fax:415-461-4764
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice