Provider Demographics
NPI:1255752663
Name:JASON M. KUESTER DDS, LLC
Entity type:Organization
Organization Name:JASON M. KUESTER DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ASSISTANT/OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-867-6428
Mailing Address - Street 1:1331 W BOONVILLE NEW HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-9583
Mailing Address - Country:US
Mailing Address - Phone:812-867-6428
Mailing Address - Fax:812-867-7494
Practice Address - Street 1:1331 W BOONVILLE NEW HARMONY RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-9583
Practice Address - Country:US
Practice Address - Phone:812-867-6428
Practice Address - Fax:812-867-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011322-A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental