Provider Demographics
NPI:1548541360
Name:DR. JOHN GEASLAND
Entity type:Organization
Organization Name:DR. JOHN GEASLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEVE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-296-7777
Mailing Address - Street 1:1916 WEST C ST.
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2367
Mailing Address - Country:US
Mailing Address - Phone:918-296-7777
Mailing Address - Fax:918-296-7768
Practice Address - Street 1:1916 WEST C ST.
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2367
Practice Address - Country:US
Practice Address - Phone:918-296-7777
Practice Address - Fax:918-296-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty