Provider Demographics
NPI:1366500696
Name:ZSCHIESCHE, JERRY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:W
Last Name:ZSCHIESCHE
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:PO BOX 669
Mailing Address - Street 2:131 ST HWY 22 EAST
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-0669
Mailing Address - Country:US
Mailing Address - Phone:254-386-8448
Mailing Address - Fax:254-386-8448
Practice Address - Street 1:131 ST HWY 22 EAST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-0669
Practice Address - Country:US
Practice Address - Phone:254-386-8448
Practice Address - Fax:254-386-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice