Individual provider Active NPI

Jeffrey Hiester, D.D.S.

  • Pediatric Dentistry
  • Evansville, IN
National Provider Identifier
1154517837
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
12010159A Issued in IN
Practice address
7200 E Virginia Street
Evansville, IN 47715
Phone
(812) 479-8609
Fax
(812) 479-5554
NPI assigned
Sep 17, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 12010159A IN Primary

Addresses

Primary practice location

7200 E Virginia Street
Evansville, IN 47715

Mailing address

7200 E Virginia Street
Evansville, IN 47715
Phone (812) 479-8609

Other practice location 1

1121 W Michigan St
Indianapolis, IN 46202-5211
Phone (317) 274-7433

Other identifiers 1

IdentifierTypeStateIssuer
200345860MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231016002756 IN Order and Referring Only - DentistPractitioner - Dentist 7416302112

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12010159AINMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Evansville Pediatric Dentistry, P.C. Pediatric Dentistry Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1154517837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 E VIRGINIA STREET",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47715",
            "telephone_number": "812-479-8609",
            "fax_number": "812-479-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 E VIRGINIA STREET",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "47715",
            "telephone_number": "812-479-8609",
            "fax_number": "812-479-5554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1121 W Michigan St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025211",
            "country_code": "US",
            "telephone_number": "317-274-7433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HIESTER",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-17",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12010159A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200345860",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.