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General NPI Number Information
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NPI Number | 1619367224
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Entity Type | Organization
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Legal Business Name | AJ GIESA DMD LLC
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 93 E PENN AVE
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City | WERNERSVILLE
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State | PA
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Zip | 19565-1628
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Country | US
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Telephone | 610-678-8395
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Fax | 610-678-0172
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Provider Business Mailing Address
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Address Line | 93 E PENN AVE
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City | WERNERSVILLE
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State | PA
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Zip | 19565-1628
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Country | US
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Telephone | 610-678-8395
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Fax | 610-678-0172
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Authorized Official
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Title or Position | CEO/DENTIST
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Name | DR. ANDREW JAMES GIESA
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Credential | D.M.D.
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Telephone | 610-678-8395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS039374
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License Number State | PA
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