Provider Demographics
NPI:1689696932
Name:GEIS, MICHAEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GEIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6150 SE 14TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1705
Mailing Address - Country:US
Mailing Address - Phone:515-287-6900
Mailing Address - Fax:515-287-9903
Practice Address - Street 1:6150 SE 14TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1705
Practice Address - Country:US
Practice Address - Phone:515-287-6900
Practice Address - Fax:515-287-9903
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA06998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0137521Medicaid