Provider Demographics
NPI:1326234659
Name:KIESSELBACH, AMY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:KIESSELBACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 LONETREE BLVD
Mailing Address - Street 2:#101
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5887
Mailing Address - Country:US
Mailing Address - Phone:916-797-3300
Mailing Address - Fax:916-797-3306
Practice Address - Street 1:6560 LONETREE BLVD
Practice Address - Street 2:#101
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5887
Practice Address - Country:US
Practice Address - Phone:916-797-3300
Practice Address - Fax:916-797-3306
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice