Provider Demographics
NPI:1619367224
Name:AJ GIESA DMD LLC
Entity Type:Organization
Organization Name:AJ GIESA DMD LLC
Other - Org Name:GREEN VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GIESA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-678-8395
Mailing Address - Street 1:93 E PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-1628
Mailing Address - Country:US
Mailing Address - Phone:610-678-8395
Mailing Address - Fax:610-678-0172
Practice Address - Street 1:93 E PENN AVE
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-1628
Practice Address - Country:US
Practice Address - Phone:610-678-8395
Practice Address - Fax:610-678-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1831278936OtherDENTAL NPI NUMBER
PA1902978067OtherDENTAL NPI NUMBER