Provider Demographics
NPI:1730280488
Name:GEISEL, EDWARD GEORGE (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:GEORGE
Last Name:GEISEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:201 NEILL LANE
Mailing Address - City:EAST BEND
Mailing Address - State:NC
Mailing Address - Zip Code:27018
Mailing Address - Country:US
Mailing Address - Phone:336-699-4327
Mailing Address - Fax:
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
Practice Address - Country:US
Practice Address - Phone:336-699-8001
Practice Address - Fax:336-699-5030
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC55901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU39089Medicare UPIN