Provider Demographics
NPI:1285715979
Name:KESLING, JEFFREY B (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:KESLING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N. LIBERTY STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-344-2747
Mailing Address - Fax:208-344-0196
Practice Address - Street 1:900 N. LIBERTY STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-344-2747
Practice Address - Fax:208-344-0196
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3334122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID905459OtherUNITED CONCORDIA
ID0001 0011493OtherREGENCE BLUE SHIELD
ID66688OtherBLUE CROSS
ID6E755OtherFEDERAL EMPLOYEE PROGRAM