Healthcare Provider Details

I. General information

NPI: 1174500920
Provider Name (Legal Business Name): JAY JAMES GEISTKEMPER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AULIKE ST
KAILUA HI
96734-2739
US

IV. Provider business mailing address

30 AULIKE ST
KAILUA HI
96734-2739
US

V. Phone/Fax

Practice location:
  • Phone: 808-235-3131
  • Fax:
Mailing address:
  • Phone: 808-235-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-024596
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDT-2420
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: