Provider Demographics
NPI:1912066267
Name:NIETER, G. JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:JOSEPH
Last Name:NIETER
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 1:23024 U.S. HWY 6
Mailing Address - Street 2:SUITE #203
Mailing Address - City:KEYSTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80435
Mailing Address - Country:US
Mailing Address - Phone:970-262-2002
Mailing Address - Fax:970-262-2045
Practice Address - Street 1:23024 US HIGHWAY 6
Practice Address - Street 2:SUITE #203
Practice Address - City:KEYSTONE
Practice Address - State:CO
Practice Address - Zip Code:80435-7725
Practice Address - Country:US
Practice Address - Phone:970-262-2002
Practice Address - Fax:970-262-2045
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice