Provider Demographics
NPI:1780128660
Name:LAM-GEISE DENTISTRY
Entity type:Organization
Organization Name:LAM-GEISE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LAM
Authorized Official - Last Name:GEISE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-220-9646
Mailing Address - Street 1:577 HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8979
Mailing Address - Country:US
Mailing Address - Phone:256-461-8607
Mailing Address - Fax:
Practice Address - Street 1:577 HUGHES RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-461-8607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5853122300000X
AL40021223G0001X
AL6107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty