MEDICARE: DR. NIESJE HUNTER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7282	KY

General Provider Information

NPI Number	:	1033281118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIESJE HUNTER DMD

Provider Business Mailing Address
First Line	:	20 N GRAND AVE STE 10
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1755
Country	:	US
Telephone Number	:	859-441-1900
Fax Number	:	859-441-1900

Provider Business Practice Location Address
First Line	:	20 N GRAND AVE STE 10
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1755
Country	:	US
Telephone Number	:	859-441-1900
Fax Number	:	859-441-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	06/23/2021

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