| Blue Phoenix Dental Llc | |
|
159 Riverside Drive Unalaska AK 99685 | |
| (907) 545-1191 | |
| Not Available |
| Full Name | Blue Phoenix Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 159 Riverside Drive, Unalaska, Alaska |
| Authorized Official Name and Position | Sean Michael Davis (DENTIST) |
| Authorized Official Contact | 9075451191 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Phoenix Dental Llc 205 E Dimond Blvd # 592 Anchorage AK 99515-1909 Ph: (907) 545-1191 | Blue Phoenix Dental Llc 159 Riverside Drive Unalaska AK 99685 Ph: (907) 545-1191 |
| NPI Number | 1134885593 |
|---|---|
| Provider Enumeration Date | 11/10/2021 |
| Last Update Date | 11/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134885593 | NPI | - | NPPES |
| 1687307 | Medicaid | AK | |
| 1663861 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
James Mushovic, D.m.d., Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 159 Riverside Dr., Unalaska, AK 99685 Phone: 907-581-3122 |