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General NPI Number Information
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NPI Number | 1811685167
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Entity Type | Individual
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Provider Name | ANDREW GEIGLE DMD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 45 CAPRI BLVD STE G
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5657
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Country | US
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Telephone | 928-888-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 440 E WILLOW AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-2830
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D011737
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License Number State | AZ
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