| NPI | 1750961918 |
|---|---|
| Doing Business As | DENTAL- NILAVENA DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | RONALD LEE OLSON Executive Vice President Finance 907-729-4939 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 125J00000X Dental Therapist | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2023-09-15 |