Provider Demographics
NPI:1770650285
Name:HIESTER, JOHN D (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:HIESTER
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 1:1751 E TIPTON ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3561
Mailing Address - Country:US
Mailing Address - Phone:812-524-8282
Mailing Address - Fax:812-522-7289
Practice Address - Street 1:1751 E TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3561
Practice Address - Country:US
Practice Address - Phone:812-524-8282
Practice Address - Fax:812-522-7289
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009235A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1317013OtherUCCI