Provider Demographics
NPI:1821090226
Name:CIESLAK, JOSEPH H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:H
Last Name:CIESLAK
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 1:5906 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1935
Mailing Address - Country:US
Mailing Address - Phone:502-231-2230
Mailing Address - Fax:
Practice Address - Street 1:5906 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1935
Practice Address - Country:US
Practice Address - Phone:502-231-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-01-26
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-08-08
Provider Licenses
StateLicense IDTaxonomies
KY7038122300000X, 204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60070380Medicaid
KY64070386Medicaid
KY1059670OtherPASSPORT ID
KY1059670OtherPASSPORT ID