| NPI | 1154544633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT SAMUEL MATTHEWS President 907-561-7110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AK 717) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |