Provider Demographics
NPI:1316123656
Name:KIEFER, ALAN RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
Last Name:KIEFER
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 1:1706 BEALL AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2378
Mailing Address - Country:US
Mailing Address - Phone:330-264-8623
Mailing Address - Fax:330-263-1853
Practice Address - Street 1:1706 BEALL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2378
Practice Address - Country:US
Practice Address - Phone:330-264-8623
Practice Address - Fax:330-263-1853
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist