| NPI | 1205147444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON W EVISON Director 907-225-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 1235) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2010-06-22 |