| NPI | 1568776961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAY R DERKSEN President 907-276-5418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AK AA0474) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2010-07-28 |