Provider Demographics
NPI:1164449898
Name:JEFFREY R. PRINSELL, DMD, MD, P.C.
Entity Type:Organization
Organization Name:JEFFREY R. PRINSELL, DMD, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRINSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:770-956-9856
Mailing Address - Street 1:1950 SPECTRUM CIR SE STE B300
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-1657
Mailing Address - Country:US
Mailing Address - Phone:770-956-9856
Mailing Address - Fax:770-956-9879
Practice Address - Street 1:1950 SPECTRUM CIR SE STE B300
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-1657
Practice Address - Country:US
Practice Address - Phone:770-956-9856
Practice Address - Fax:770-956-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN 010735261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery