=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700098225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY ELISE GEERS D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 03/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 CASCADE STREET
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-798-2910
-----------------------------------------------------
Fax | 909-798-6973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 TERRACINA BLVD STE 207B
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92373-4869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-798-2228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 37331
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------