| NPI | 1316527575 |
|---|---|
| Doing Business As | DENTAL- FIREWEED DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | RONALD LEE OLSON Executive Vice President Finance 907-729-4939 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2023-09-01 |