MEDICARE: EDWARD G GEISEL DDS PLLC

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	NC5590	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669682159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD G GEISEL DDS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:	201 NEILL LN
City	:	EAST BEND
State	:	NC
Zip	:	27018-0130
Country	:	US
Telephone Number	:	336-699-8001
Fax Number	:	336-699-5030

Provider Business Practice Location Address
First Line	:	201 NEILL LN
Second Line	:
City	:	EAST BEND
State	:	NC
Zip	:	27018-0130
Country	:	US
Telephone Number	:	336-699-8001
Fax Number	:	336-699-5030

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD GEORGE GEISEL
Credential	:	DDS
Telephone Number	:	336-699-8001

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/21/2017

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