MEDICARE: EDWARD VANCE GESCHELIN DMD

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	10573	MA

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	:	1942202023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD VANCE GESCHELIN DMD

Provider Business Mailing Address
First Line	:	500 E BROADWAY
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-4406
Country	:	US
Telephone Number	:	617-268-2333
Fax Number	:	617-268-8894

Provider Business Practice Location Address
First Line	:	500 E BROADWAY
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-4406
Country	:	US
Telephone Number	:	617-268-2333
Fax Number	:	617-268-8894

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	02/13/2008

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