| NPI | 1467124560 |
|---|---|
| Doing Business As | DENTAL- AMBASSADOR DRIVE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | RONALD LEE OLSON Executive Vice President Finance 907-729-4939 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2023-09-13 |