Provider Demographics
NPI:1306194931
Name:KIESLING, MARI ROSE (DMD)
Entity type:Individual
Prefix:MRS
First Name:MARI
Middle Name:ROSE
Last Name:KIESLING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:MARI
Other - Middle Name:ROSE
Other - Last Name:BEITMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1221 HELENA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2971
Mailing Address - Country:US
Mailing Address - Phone:406-417-3456
Mailing Address - Fax:
Practice Address - Street 1:1221 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2971
Practice Address - Country:US
Practice Address - Phone:406-417-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8331302-9922122300000X
MT60861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist