Provider Demographics
NPI:1215193974
Name:JOSEPH H. CIESLAK, DDS, PLLC
Entity Type:Organization
Organization Name:JOSEPH H. CIESLAK, DDS, PLLC
Other - Org Name:LOUISVILLE ORAL SURGERY & DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:CIESLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:502-231-2230
Mailing Address - Street 1:5906 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1935
Mailing Address - Country:US
Mailing Address - Phone:502-231-2230
Mailing Address - Fax:502-231-3443
Practice Address - Street 1:5906 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1935
Practice Address - Country:US
Practice Address - Phone:502-231-2230
Practice Address - Fax:502-231-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7038174400000X
KY7038332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64070386Medicaid
KY1059670OtherPASSPORT