Provider Demographics
NPI:1669682159
Name:EDWARD G GEISEL DDS PLLC
Entity Type:Organization
Organization Name:EDWARD G GEISEL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-699-8001
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:201 NEILL LN
Mailing Address - City:EAST BEND
Mailing Address - State:NC
Mailing Address - Zip Code:27018-0130
Mailing Address - Country:US
Mailing Address - Phone:336-699-8001
Mailing Address - Fax:336-699-5030
Practice Address - Street 1:201 NEILL LN
Practice Address - Street 2:
Practice Address - City:EAST BEND
Practice Address - State:NC
Practice Address - Zip Code:27018-0130
Practice Address - Country:US
Practice Address - Phone:336-699-8001
Practice Address - Fax:336-699-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC55901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993141Medicaid
NCU39089Medicare UPIN