Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901019442 | MI |
N | 1223E0200X | Endodontist | 2901019442 | MI |
Y | 1223E0200X | Endodontist | 36891 | TX |
NPI | 1083710438 |
---|---|
Provider Name | Dr. Jelena Seibold |
First Address | Jbsa Lackland, TX 78236-5638 |
Second Address | Jbsa Lackland, TX 78236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 01/06/2021 |