Individual
DR. JONATHAN W HIEMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
6604 BARDSTOWN RD, SUITE: B, LOUISVILLE, KY 40291-3045
(502) 239-6850
(502) 239-3425
Mailing address
6604 BARDSTOWN RD, SUITE: B, LOUISVILLE, KY 40291-3045
(502) 239-6850
(502) 239-3425
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6188
KY
1223G0001X
General Practice Dentistry
6188
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
469970
UNITED CONCORDIA
KY
05
—
60061884
—
KY
01
—
6342
PASSPORT PROVIDER NUMBER
KY
01
—
Y292
BCBS PROVIDER NUMBER
KY
Enumeration date
08/31/2005
Last updated
08/31/2015
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