Healthcare Provider Details

I. General information

NPI: 1083710438
Provider Name (Legal Business Name): JELENA SEIBOLD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KNIK GOOSE BAY RD
WASILLA AK
99654-8083
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-631-7690
  • Fax:
Mailing address:
  • Phone: 907-729-6801
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number36891
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901019442
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019442
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number235832
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: