Provider Demographics
NPI:1851430680
Name:CHIESA, DAVID BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:CHIESA
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 1:559 VINCENT STREET
Mailing Address - Street 2:ATTN: 21 DS/SGD - DENTAL CLINIC
Mailing Address - City:PETERSON AFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-1329
Mailing Address - Fax:866-867-7926
Practice Address - Street 1:559 VINCENT STREET
Practice Address - Street 2:ATTN: 21 DS/SGD - DENTAL CLINIC
Practice Address - City:PETERSON AFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-1329
Practice Address - Fax:866-867-7926
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00158991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice