Provider Demographics
NPI:1558965350
Name:GEISELHOFER LIMITED
Entity Type:Organization
Organization Name:GEISELHOFER LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GEISELHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:708-650-6229
Mailing Address - Street 1:2205 W 136TH AVE STE 106
Mailing Address - Street 2:
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:
Practice Address - Street 1:609 W 130TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2812
Practice Address - Country:US
Practice Address - Phone:708-650-6229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEISELHOFER LIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3915511Medicaid