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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1306835103

Individual Registrant:
Gender: M

Location and contact information for practice:
Tel: 907-580-5010  Fax: --

Contact information for business:
Tel: 907-753-0251  Fax: --

Registration Information:
NPI: 1306835103
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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