Healthcare Provider Details

I. General information

NPI: 1730280488
Provider Name (Legal Business Name): EDWARD GEORGE GEISEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NEILL LN
EAST BEND NC
27018
US

IV. Provider business mailing address

PO BOX 130 201 NEILL LANE
EAST BEND NC
27018
US

V. Phone/Fax

Practice location:
  • Phone: 336-699-8001
  • Fax: 336-699-5030
Mailing address:
  • Phone: 336-699-4327
  • Fax:

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:
Title or Position:
Credential:
Phone: