Provider Demographics
NPI:1912903956
Name:KNEISLEY, RICHARD R
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:KNEISLEY
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 1:5677 SCIOTO DARBY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1391
Mailing Address - Country:US
Mailing Address - Phone:614-771-6862
Mailing Address - Fax:614-771-7467
Practice Address - Street 1:5677 SCIOTO DARBY RD
Practice Address - Street 2:STE 300
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1391
Practice Address - Country:US
Practice Address - Phone:614-771-6862
Practice Address - Fax:614-771-7467
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH160831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice