Provider Demographics
NPI:1912381591
Name:GEELAN, KYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:GEELAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26700 S US HIGHWAY 85
Mailing Address - Street 2:ASPC LEWIS CORIZON HEALTH CARE
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-5024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26700 S US HIGHWAY 85
Practice Address - Street 2:ASPC LEWIS CORIZON HEALTH CARE
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-5024
Practice Address - Country:US
Practice Address - Phone:623-386-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist