Provider Demographics
NPI:1821025768
Name:DR JB GEILER PC
Entity Type:Organization
Organization Name:DR JB GEILER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:719-545-7600
Mailing Address - Street 1:501 QUINCY STREET
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2064
Mailing Address - Country:US
Mailing Address - Phone:719-545-7600
Mailing Address - Fax:719-545-1594
Practice Address - Street 1:501 QUINCY STREET
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2064
Practice Address - Country:US
Practice Address - Phone:719-545-7600
Practice Address - Fax:719-545-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02000552Medicaid