| NPI | 1841580966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROC WAYNE BRIMHALL Dentist 907-248-7275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AK 1308) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |