| NPI | 1669057279 |
|---|---|
| Doing Business As | DENTAL- VILLAGE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | RONALD LEE OLSON Executive Vice President Finance 907-729-4939 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2023-09-19 |