Provider Demographics
NPI:1457368250
Name:GEASLAND, JOHN ALFRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALFRED
Last Name:GEASLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S MOCCASIN AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3454
Mailing Address - Country:US
Mailing Address - Phone:918-456-7722
Mailing Address - Fax:
Practice Address - Street 1:314 E DOWNING ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3014
Practice Address - Country:US
Practice Address - Phone:918-456-4571
Practice Address - Fax:918-456-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice