Provider Demographics
NPI:1770029324
Name:GEISE DENTISTRY, LLC
Entity type:Organization
Organization Name:GEISE DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:GEISE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-331-9229
Mailing Address - Street 1:1111 GLENEAGLES DR SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7417
Mailing Address - Country:US
Mailing Address - Phone:256-881-7080
Mailing Address - Fax:
Practice Address - Street 1:1111 GLENEAGLES DR SW
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7417
Practice Address - Country:US
Practice Address - Phone:256-881-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6107122300000X
AL3526122300000X
AL5853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty