Provider Demographics
NPI:1881625606
Name:AHLERT, JEFFREY J (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:AHLERT
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 1:14600 E 88TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4877
Mailing Address - Country:US
Mailing Address - Phone:918-272-1444
Mailing Address - Fax:918-272-6731
Practice Address - Street 1:14600 E 88TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4877
Practice Address - Country:US
Practice Address - Phone:918-272-1444
Practice Address - Fax:918-272-6731
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100080920*21Medicaid