Provider Demographics
NPI:1902971062
Name:KIESEL DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:KIESEL DENTAL ASSOCIATES, P.C.
Other - Org Name:KIESEL & GOWDA DENTAL ASSOCIATES, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-536-1717
Mailing Address - Street 1:355 EDGEMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951
Mailing Address - Country:US
Mailing Address - Phone:215-536-1717
Mailing Address - Fax:215-529-9809
Practice Address - Street 1:355 EDGEMONT AVENUE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-1717
Practice Address - Fax:215-529-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021954L122300000X
PADS039978122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty