| Dental Innovations | |
|
3161 E Palmer Wasilla Hwy Ste 5 Wasilla AK 99654-7271 | |
| (907) 357-5214 | |
| (907) 357-5213 |
| Full Name | Dental Innovations |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3161 E Palmer Wasilla Hwy, Wasilla, Alaska |
| Authorized Official Name and Position | Kelly Wade Lucas (OWNER/PRACTITIONER) |
| Authorized Official Contact | 9073575214 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Innovations 3161 E Palmer Wasilla Hwy Ste 5 Wasilla AK 99654-7271 Ph: (907) 357-5214 | Dental Innovations 3161 E Palmer Wasilla Hwy Ste 5 Wasilla AK 99654-7271 Ph: (907) 357-5214 |
| NPI Number | 1376089128 |
|---|---|
| Provider Enumeration Date | 01/17/2017 |
| Last Update Date | 01/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376089128 | NPI | - | NPPES |
| 1003119 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 673 (Alaska) | Primary |
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