Individual
JESSICA L KIECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1532 W BROADWAY STE 101, MONONA, WI 53713-1827
(608) 221-3326
(608) 221-9726
Mailing address
1532 W BROADWAY STE 101, MONONA, WI 53713-1827
(608) 221-3326
(608) 221-9726
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6337
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740792969
PRACTICE NPI MONONA
WI
01
—
1992217053
PRACTICE NPI EAST
WI
Enumeration date
01/27/2009
Last updated
07/07/2023
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