Provider Demographics
NPI:1528199049
Name:GEICK, GORDON FRANCIS
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:FRANCIS
Last Name:GEICK
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 1:50 NASHUA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3400
Mailing Address - Country:US
Mailing Address - Phone:603-432-2961
Mailing Address - Fax:
Practice Address - Street 1:50 NASHUA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3400
Practice Address - Country:US
Practice Address - Phone:603-432-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist