| Lifehouse Dental Clinic | |
|
11495 N. Callison Street Sutton AK 99674 | |
| (907) 631-7665 | |
| Not Available |
| Full Name | Lifehouse Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11495 N. Callison Street, Sutton, Alaska |
| Authorized Official Name and Position | Ronald Lee Olson (EXECUTIVE VICE PRESIDENT FINANCE) |
| Authorized Official Contact | 9077294939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifehouse Dental Clinic Po Box 35151 Seattle WA 98124-5151 Ph: () - | Lifehouse Dental Clinic 11495 N. Callison Street Sutton AK 99674 Ph: (907) 631-7665 |
| NPI Number | 1043767940 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 08/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043767940 | NPI | - | NPPES |
| 1654481 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20467 (Alaska) | Primary |