MEDICARE: DINA J GIESLER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	011662	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	154565	OTHER		UNITED CONCORDIA INS

General Provider Information

NPI Number	:	1316161235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA J GIESLER DDS

Provider Business Mailing Address
First Line	:	4405 NORTHSIDE PKWY NW
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30327-5202
Country	:	US
Telephone Number	:	404-262-7733
Fax Number	:	404-262-1023

Provider Business Practice Location Address
First Line	:	4405 NORTHSIDE PKWY NW
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30327-5202
Country	:	US
Telephone Number	:	404-262-7733
Fax Number	:	404-262-1023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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