| NPI | 1720116601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN KINGSLIEN Director Secretary Treasurer 907-346-2625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 348) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |