Healthcare Provider Details

I. General information

NPI: 1336724160
Provider Name (Legal Business Name): ANDREA IVY GEFFIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SCIENCE DR STE 100
MADISON WI
53711-1064
US

IV. Provider business mailing address

2409 PARMENTER ST APT 402
MIDDLETON WI
53562-2687
US

V. Phone/Fax

Practice location:
  • Phone: 608-836-1020
  • Fax:
Mailing address:
  • Phone: 203-695-8797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001472
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: