Provider Demographics
NPI:1912241795
Name:KELLY M. GIERA, D.D.S., P.C.
Entity Type:Organization
Organization Name:KELLY M. GIERA, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-528-2270
Mailing Address - Street 1:650 E BIG BEAVER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 E BIG BEAVER RD
Practice Address - Street 2:SUITE D
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1432
Practice Address - Country:US
Practice Address - Phone:248-528-2270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty