Provider Demographics
NPI:1740355890
Name:GEIS, MARK EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:GEIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:6150 SE 14TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1705
Mailing Address - Country:US
Mailing Address - Phone:515-287-6900
Mailing Address - Fax:515-287-9903
Practice Address - Street 1:6150 SE 14TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1705
Practice Address - Country:US
Practice Address - Phone:515-287-6900
Practice Address - Fax:515-287-9903
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA07132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0137513Medicaid