| NPI | 1831677814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTI FORREST Manager 907-373-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 1248) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |