| NPI | 1528541752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIE MICHELLE GARRABRANT Office Manager 907-276-7787 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2018-09-13 |