Provider Demographics
NPI:1093311300
Name:NESIBA SURGICAL ARTS PLLC
Entity Type:Organization
Organization Name:NESIBA SURGICAL ARTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NESIBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:303-777-1603
Mailing Address - Street 1:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1119
Mailing Address - Country:US
Mailing Address - Phone:303-777-1603
Mailing Address - Fax:303-777-1694
Practice Address - Street 1:3955 E EXPOSITION AVE STE 520
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5030
Practice Address - Country:US
Practice Address - Phone:303-777-1603
Practice Address - Fax:303-777-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty