MEDICARE: DR. JEFFREY HIESTER D.D.S.

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	1223P0221X	Pediatric Dentistry	12010159A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154517837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY HIESTER D.D.S.

Provider Business Mailing Address
First Line	:	7200 E VIRGINIA STREET
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715
Country	:	US
Telephone Number	:	812-479-8609
Fax Number	:	812-479-5554

Provider Business Practice Location Address
First Line	:	7200 E VIRGINIA STREET
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715
Country	:	US
Telephone Number	:	812-479-8609
Fax Number	:	812-479-5554

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	05/26/2026

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