Provider Demographics
NPI:1942369236
Name:JOHN D HIESTER, DDS, MSD
Entity Type:Organization
Organization Name:JOHN D HIESTER, DDS, MSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HIESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-524-8282
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009235A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty