Provider Demographics
NPI:1952311169
Name:GEISE, SCOTT DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DANIEL
Last Name:GEISE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-1203
Mailing Address - Country:US
Mailing Address - Phone:716-778-7449
Mailing Address - Fax:716-778-0721
Practice Address - Street 1:2727 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-1203
Practice Address - Country:US
Practice Address - Phone:716-778-7449
Practice Address - Fax:716-778-0721
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0420881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice