Provider Demographics
NPI:1831600923
Name:DEVINN L. GEESON DDS, PLLC
Entity type:Organization
Organization Name:DEVINN L. GEESON DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEVINN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-663-1223
Mailing Address - Street 1:1065 SANDY GROVE PL
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9489
Mailing Address - Country:US
Mailing Address - Phone:919-625-7132
Mailing Address - Fax:
Practice Address - Street 1:1215 WESTGATE DRIVE
Practice Address - Street 2:#180
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451
Practice Address - Country:US
Practice Address - Phone:910-663-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99911223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902E7Medicaid