Healthcare Provider Details

I. General information

NPI: 1437501335
Provider Name (Legal Business Name): GINA M GEFFRE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N MAIN AVE
SIOUX FALLS SD
57104-5948
US

IV. Provider business mailing address

8702 W WISEMAN ST
SIOUX FALLS SD
57106-4877
US

V. Phone/Fax

Practice location:
  • Phone: 605-367-8022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number639
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: