Provider Demographics
NPI:1588830434
Name:ALAN R. KIEFER, D.D.S.
Entity Type:Organization
Organization Name:ALAN R. KIEFER, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-264-8623
Mailing Address - Street 1:1706 BEALL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2378
Mailing Address - Country:US
Mailing Address - Phone:330-264-8623
Mailing Address - Fax:330-263-1853
Practice Address - Street 1:1706 BEALL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2378
Practice Address - Country:US
Practice Address - Phone:330-264-8623
Practice Address - Fax:330-263-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270479Medicaid