Provider Demographics
NPI:1780970228
Name:GEISE, JAMES TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TYLER
Last Name:GEISE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1160
Mailing Address - Country:US
Mailing Address - Phone:256-464-3556
Mailing Address - Fax:256-464-3553
Practice Address - Street 1:136 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1160
Practice Address - Country:US
Practice Address - Phone:256-464-3556
Practice Address - Fax:256-464-3553
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD5853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist