MEDICARE: JAMES PETER KIERL DDS MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4204	OK

General Provider Information

NPI Number	:	1548228174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PETER KIERL DDS MS

Provider Business Mailing Address
First Line	:	171 SE 33RD ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-4602
Country	:	US
Telephone Number	:	405-341-5020
Fax Number	:	405-341-0271

Provider Business Practice Location Address
First Line	:	171 SE 33RD ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-4602
Country	:	US
Telephone Number	:	405-341-5020
Fax Number	:	405-341-0271

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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