MEDICARE: DR. JESSIE KIERL

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	6887	OK
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	270	OK

General Provider Information

NPI Number	:	1831633296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSIE KIERL

Provider Business Mailing Address
First Line	:	2509 THUNDERWIND CIR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6880
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 E 33RD ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-4602
Country	:	US
Telephone Number	:	53-415-0204
Fax Number	:

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

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	08/21/2024

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