Provider Demographics
NPI:1306061452
Name:GEIVELIS, MILTIADES (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MILTIADES
Middle Name:
Last Name:GEIVELIS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MILTON
Other - Middle Name:
Other - Last Name:GEIVELIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:5N613 CREEK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6277
Mailing Address - Country:US
Mailing Address - Phone:630-584-2452
Mailing Address - Fax:630-584-8301
Practice Address - Street 1:106 W BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-7880
Practice Address - Country:US
Practice Address - Phone:630-830-4930
Practice Address - Fax:630-830-4953
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics