Provider Demographics
NPI:1740280528
Name:GIESY, MICHAEL JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:GIESY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6004 WESTGATE BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2503
Mailing Address - Country:US
Mailing Address - Phone:253-752-6630
Mailing Address - Fax:253-752-1173
Practice Address - Street 1:6004 WESTGATE BLVD
Practice Address - Street 2:STE 210
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2503
Practice Address - Country:US
Practice Address - Phone:253-752-6630
Practice Address - Fax:253-752-1173
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA84591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice