Provider Demographics
NPI:1790646859
Name:GEIST ORTHO GROUP, LLC.
Entity type:Organization
Organization Name:GEIST ORTHO GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:317-507-9820
Mailing Address - Street 1:8140 OAKLANDON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9543
Mailing Address - Country:US
Mailing Address - Phone:317-823-8338
Mailing Address - Fax:317-823-8420
Practice Address - Street 1:8418 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1506
Practice Address - Country:US
Practice Address - Phone:317-585-7491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty