| NPI | 1346254851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM RANDY DEETER President 907-561-1430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AK 18698) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2008-04-10 |