Provider Demographics
NPI:1609034727
Name:DR GARY GEACCONE
Entity Type:Organization
Organization Name:DR GARY GEACCONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEACCONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-332-9565
Mailing Address - Street 1:608 W MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3884
Mailing Address - Country:US
Mailing Address - Phone:281-332-9565
Mailing Address - Fax:281-554-9066
Practice Address - Street 1:608 B WEST MAIN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-332-9565
Practice Address - Fax:281-554-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD144011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty