| NPI | 1649385006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE EDWARD GRAVES President 907-336-7337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 432159) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-08-22 |