Healthcare Provider Details

I. General information

NPI: 1669682159
Provider Name (Legal Business Name): EDWARD G GEISEL DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NEILL LN
EAST BEND NC
27018-0130
US

IV. Provider business mailing address

PO BOX 130 201 NEILL LN
EAST BEND NC
27018-0130
US

V. Phone/Fax

Practice location:
  • Phone: 336-699-8001
  • Fax: 336-699-5030
Mailing address:
  • Phone: 336-699-8001
  • Fax: 336-699-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberNC5590
License Number StateNC

VIII. Authorized Official

Name: DR. EDWARD GEORGE GEISEL
Title or Position: OWNER
Credential: DDS
Phone: 336-699-8001