Provider Demographics
NPI:1225139652
Name:GEIST, JAMES RICHARD
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:GEIST
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 1:8200 W OUTER DR
Mailing Address - Street 2:BOX 129
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3580
Mailing Address - Country:US
Mailing Address - Phone:313-494-6675
Mailing Address - Fax:
Practice Address - Street 1:8200 W OUTER DR
Practice Address - Street 2:BOX 129
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3580
Practice Address - Country:US
Practice Address - Phone:313-494-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010146211223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology