Provider Demographics
NPI:1245700541
Name:PAGODA DENTAL GROUP OF OLEY, PLLC
Entity type:Organization
Organization Name:PAGODA DENTAL GROUP OF OLEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIESA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-627-9291
Mailing Address - Street 1:4906 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-8609
Mailing Address - Country:US
Mailing Address - Phone:610-678-8395
Mailing Address - Fax:
Practice Address - Street 1:2 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547-1954
Practice Address - Country:US
Practice Address - Phone:610-987-6746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental