Provider Demographics
NPI:1538267364
Name:GEISLER, STACY A (DDS PHD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:GEISLER
Suffix:
Gender:F
Credentials:DDS PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16699 BOONES FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-534-0114
Mailing Address - Fax:503-534-0117
Practice Address - Street 1:16699 BOONES FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-534-0114
Practice Address - Fax:503-534-0117
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD80781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery