Provider Demographics
NPI:1922294701
Name:NIESKENS, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:NIESKENS
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 1:60 HANCOCK ROAD
Mailing Address - Street 2:ROUTE 202 NORTH
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1107
Mailing Address - Country:US
Mailing Address - Phone:603-924-3350
Mailing Address - Fax:603-924-2199
Practice Address - Street 1:60 HANCOCK ROAD
Practice Address - Street 2:ROUTE 202 NORTH
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1107
Practice Address - Country:US
Practice Address - Phone:603-924-3350
Practice Address - Fax:603-924-2199
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1839OtherLIC NUMBER
NH30302680Medicaid