Provider Demographics
NPI:1730150442
Name:GEISSLER, OTTO WALTER III (DDS)
Entity type:Individual
Prefix:DR
First Name:OTTO
Middle Name:WALTER
Last Name:GEISSLER
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 OLIVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1210
Mailing Address - Country:US
Mailing Address - Phone:209-722-2435
Mailing Address - Fax:209-722-7671
Practice Address - Street 1:1132 OLIVEWOOD DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1210
Practice Address - Country:US
Practice Address - Phone:209-722-2435
Practice Address - Fax:209-722-7671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB18834-01Medicaid