Provider Demographics
NPI:1366597197
Name:KIERSZ DENTISTRY INC
Entity type:Organization
Organization Name:KIERSZ DENTISTRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIERSZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-336-5599
Mailing Address - Street 1:441 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-5603
Mailing Address - Country:US
Mailing Address - Phone:573-336-5599
Mailing Address - Fax:573-336-4809
Practice Address - Street 1:441 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-5603
Practice Address - Country:US
Practice Address - Phone:573-336-5599
Practice Address - Fax:573-336-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0160511223G0001X
MO0158821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty