| NPI | 1588113187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE MARIE DONALDSON RANDOLPH General Dentist 907-486-3269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 1346) |
| Enumeration Date | 2016-09-25 |
| Last Update Date | 2016-09-25 |