| NPI | 1568028587 |
|---|---|
| Doing Business As | WASILLA DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | JUSTIN WILLIAM COFFMAN Member/Owner 907-376-5315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2019-05-15 |