Provider Demographics
NPI:1275087819
Name:GEISELHOFER, JENNIFER LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:GEISELHOFER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W 136TH AVE
Mailing Address - Street 2:106-159
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9306
Mailing Address - Country:US
Mailing Address - Phone:708-650-6229
Mailing Address - Fax:720-390-6151
Practice Address - Street 1:2205 W 136TH AVE
Practice Address - Street 2:106-159
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9306
Practice Address - Country:US
Practice Address - Phone:708-650-6229
Practice Address - Fax:720-390-6151
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904537124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist