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General NPI Number Information
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NPI Number | 1780756718
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Entity Type | Organization
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Legal Business Name | GIESTING FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 05/10/2019
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Provider Practice Location Address
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Address Line | 10130 OXFORD PIKE
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City | BROOKVILLE
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State | IN
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Zip | 47012-9414
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Country | US
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Telephone | 765-647-2511
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Fax | 765-647-6840
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Provider Business Mailing Address
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Address Line | PO BOX D
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City | BROOKVILLE
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State | IN
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Zip | 47012
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Country | US
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Telephone | 765-647-2511
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Fax | 765-647-6840
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Authorized Official
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Title or Position | GENERAL DENTIST / OWNER
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Name | JACOB A GIESTING
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Credential | DDS
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Telephone | 765-647-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12007150
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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