| NPI | 1063231488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK B DUCLOS Orthodontist 907-272-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-10-03 |
| Last Update Date | 2024-10-03 |