Healthcare Provider Details

I. General information

NPI: 1841587615
Provider Name (Legal Business Name): JENNIFER SARSLAND DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HIGHWAY 12 W
BOWMAN ND
58623-4507
US

IV. Provider business mailing address

608 HIGHWAY 12 W
BOWMAN ND
58623-4507
US

V. Phone/Fax

Practice location:
  • Phone: 701-523-3255
  • Fax:
Mailing address:
  • Phone: 701-523-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2101
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: