Provider Demographics
NPI:1780710186
Name:SCIESZINSKI, JOHN J (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:SCIESZINSKI
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 1:26 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-2041
Mailing Address - Country:US
Mailing Address - Phone:641-932-2729
Mailing Address - Fax:641-932-7036
Practice Address - Street 1:26 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531-2041
Practice Address - Country:US
Practice Address - Phone:641-932-2729
Practice Address - Fax:641-932-7036
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA066961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAEJ0065OtherJOHN DEERE
IA1184333Medicaid
IA184333OtherDELTA DENTAL