| NPI | 1154672558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARA M. MABRY Owner 907-337-9448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AK 1200) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: AK 377) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2012-09-25 |