| NPI | 1851601967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELIZABETH WILLIARD Clinical Site Director 907-729-5602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 6615) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2010-10-14 |