Provider Demographics
NPI:1750553806
Name:KIESER, YOLANDA (DMD)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:KIESER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 S CLEVELAND AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2977
Mailing Address - Country:US
Mailing Address - Phone:860-841-5198
Mailing Address - Fax:
Practice Address - Street 1:11801 S CLEVELAND AVE STE 140
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2977
Practice Address - Country:US
Practice Address - Phone:860-841-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN183991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty