MEDICARE: NIESSLEIN DENTAL ASSOCIATES

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	1223G0001X	General Practice Dentistry	DS021230L	PA

General Provider Information

NPI Number	:	1215059076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIESSLEIN DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	4176 NATIONAL PIKE
Second Line	:
City	:	FARMINGTON
State	:	PA
Zip	:	15437-1344
Country	:	US
Telephone Number	:	724-329-8565
Fax Number	:	724-329-8565

Provider Business Practice Location Address
First Line	:	4176 NATIONAL PIKE
Second Line	:
City	:	FARMINGTON
State	:	PA
Zip	:	15437-1344
Country	:	US
Telephone Number	:	724-329-8565
Fax Number	:	724-329-8565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID M NIESSLEIN
Credential	:	DMD
Telephone Number	:	724-329-8565

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/29/2008

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