MEDICARE: JOHN D HIESTER DDS

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	12009235A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1317013	OTHER	IN	UCCI

General Provider Information

NPI Number	:	1770650285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D HIESTER DDS

Provider Business Mailing Address
First Line	:	857 S AUTO MALL RD
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5447
Country	:	US
Telephone Number	:	812-494-7332
Fax Number	:

Provider Business Practice Location Address
First Line	:	857 S AUTO MALL RD
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5447
Country	:	US
Telephone Number	:	812-494-7332
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	06/02/2026

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