Individual
MR. JACK R KNEISLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
221 E HOME RD, SPRINGFIELD, OH 45503
(937) 399-4470
(937) 399-3338
Mailing address
221 E HOME RD, SPRINGFIELD, OH 45503
(937) 399-4470
(937) 399-3338
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12426
MA
1223G0001X
General Practice Dentistry
1282
NH
1223G0001X
General Practice Dentistry
Primary
14578
OH
Other
Enumeration date
07/28/2006
Last updated
07/08/2007
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