| NPI | 1093042194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA JEON CEO 907-222-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AK 1239) |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2022-01-11 |