Provider Demographics
NPI:1780756718
Name:GIESTING FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:GIESTING FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIESTING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-647-2511
Mailing Address - Street 1:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012
Mailing Address - Country:US
Mailing Address - Phone:765-647-2511
Mailing Address - Fax:765-647-6840
Practice Address - Street 1:10130 OXFORD PIKE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-9414
Practice Address - Country:US
Practice Address - Phone:765-647-2511
Practice Address - Fax:765-647-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007150122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty