Provider Demographics
NPI:1609902600
Name:KIESEL, DONNA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:KIESEL
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 1:1703 E BELT LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9606
Mailing Address - Country:US
Mailing Address - Phone:372-420-4488
Mailing Address - Fax:469-635-3509
Practice Address - Street 1:1703 E BELT LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-9606
Practice Address - Country:US
Practice Address - Phone:372-420-4488
Practice Address - Fax:469-635-3509
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice