| NPI | 1023294113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN KINGSLIEN Office Manager 907-376-4415 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 348) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: AK 348) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-01-18 |