Healthcare Provider Details

I. General information

NPI: 1770650285
Provider Name (Legal Business Name): JOHN D HIESTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 S AUTO MALL RD
BLOOMINGTON IN
47401-5447
US

IV. Provider business mailing address

857 S AUTO MALL RD
BLOOMINGTON IN
47401-5447
US

V. Phone/Fax

Practice location:
  • Phone: 812-494-7332
  • Fax:
Mailing address:
  • Phone: 812-494-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12009235A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: