Provider Demographics
NPI:1962797217
Name:PRIESTLEY, ABRAHAM JORDAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:JORDAN
Last Name:PRIESTLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:JORDAN
Other - Last Name:PRIESTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11961 HERITAGE OAK PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2461
Mailing Address - Country:US
Mailing Address - Phone:503-805-6225
Mailing Address - Fax:
Practice Address - Street 1:11961 HERITAGE OAK PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2461
Practice Address - Country:US
Practice Address - Phone:503-805-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296731223P0221X
WI10010351223P0221X
CA1001011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry