| Four Corners Dental Group Fairbanks | |
|
3487 Airport Way Fairbanks AK 99709-4761 | |
| (907) 479-7771 | |
| (907) 479-7772 |
| Full Name | Four Corners Dental Group Fairbanks |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3487 Airport Way, Fairbanks, Alaska |
| Authorized Official Name and Position | Shane D Rhoton (DENTIST) |
| Authorized Official Contact | 9074797771 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Corners Dental Group Fairbanks 3487 Airport Way Fairbanks AK 99709-4761 Ph: (907) 479-7771 | Four Corners Dental Group Fairbanks 3487 Airport Way Fairbanks AK 99709-4761 Ph: (907) 479-7771 |
| NPI Number | 1710310073 |
|---|---|
| Provider Enumeration Date | 08/09/2013 |
| Last Update Date | 08/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710310073 | NPI | - | NPPES |
| DD0143 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1262 (Alaska) | Primary |
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