Provider Demographics
NPI:1407398977
Name:PRISCILA J. JELSING, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:PRISCILA J. JELSING, D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRISCILA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:JELSING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-671-8748
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545
Mailing Address - Country:US
Mailing Address - Phone:918-671-8748
Mailing Address - Fax:
Practice Address - Street 1:2106 S ATLANTA PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114
Practice Address - Country:US
Practice Address - Phone:918-743-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty