Provider Demographics
NPI:1134254170
Name:GEIST ORAL & FACIAL SURGERY, PC
Entity type:Organization
Organization Name:GEIST ORAL & FACIAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-823-4260
Mailing Address - Street 1:8170 OAKLANDON RD
Mailing Address - Street 2:STE. B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9543
Mailing Address - Country:US
Mailing Address - Phone:317-823-4260
Mailing Address - Fax:317-823-4270
Practice Address - Street 1:8170 OAKLANDON RD
Practice Address - Street 2:STE. B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9543
Practice Address - Country:US
Practice Address - Phone:317-823-4260
Practice Address - Fax:317-823-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008680A1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200133480Medicaid
IN200133480Medicaid
IN673540Medicare PIN