Provider Demographics
NPI:1184331001
Name:KIESEL, DENNIS
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:KIESEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2033
Mailing Address - Country:US
Mailing Address - Phone:724-468-5565
Mailing Address - Fax:
Practice Address - Street 1:195 SHEFFIELD DR STE B
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-1744
Practice Address - Country:US
Practice Address - Phone:724-468-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1386723054OtherNPI