MEDICARE: ANDREW GEIGLE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D011737	AZ

General Provider Information

NPI Number	:	1811685167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW GEIGLE DMD

Provider Business Mailing Address
First Line	:	440 E WILLOW AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 CAPRI BLVD STE G
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5657
Country	:	US
Telephone Number	:	928-888-1888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/25/2023

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