Provider Demographics
NPI:1467654905
Name:ARCHIBALD, GEOFFREY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:DAVID
Last Name:ARCHIBALD
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 1:1541 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1416
Mailing Address - Country:US
Mailing Address - Phone:612-623-3079
Mailing Address - Fax:
Practice Address - Street 1:6460 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-7030
Practice Address - Country:US
Practice Address - Phone:651-674-7096
Practice Address - Fax:651-674-7097
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice