Provider Demographics
NPI:1164436614
Name:NIEDZIELA, JEFFREY STUART (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STUART
Last Name:NIEDZIELA
Suffix:
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 1:135 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2401
Mailing Address - Country:US
Mailing Address - Phone:262-691-3931
Mailing Address - Fax:262-691-3938
Practice Address - Street 1:135 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2401
Practice Address - Country:US
Practice Address - Phone:262-691-3931
Practice Address - Fax:262-691-3938
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6007-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice