=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134278302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY M GIERA DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2007
-----------------------------------------------------
Last Update Date | 01/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 E BIG BEAVER RD SUITE D
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48083-1432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-528-2270
-----------------------------------------------------
Fax | 248-528-2377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 E BIG BEAVER RD SUITE D
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48083-1432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-528-2270
-----------------------------------------------------
Fax | 248-528-2377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2901018984
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------