Healthcare Provider Details

I. General information

NPI: 1538267364
Provider Name (Legal Business Name): STACY A GEISLER DDS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16699 BOONES FERRY RD SUITE 100
LAKE OSWEGO OR
97035
US

IV. Provider business mailing address

16699 BOONES FERRY RD SUITE 100
LAKE OSWEGO OR
97035
US

V. Phone/Fax

Practice location:
  • Phone: 503-534-0114
  • Fax: 503-534-0117
Mailing address:
  • Phone: 503-534-0114
  • Fax: 503-534-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD8078
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: