Provider Demographics
NPI:1326277906
Name:NESIBA, JOHN ROBERT (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:NESIBA
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2636
Mailing Address - Country:US
Mailing Address - Phone:402-730-5776
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
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010205041223S0112X
CO00608571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery