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436 5th & Ted Stevens Way Kotzebue AK 99752 | |
| (907) 442-3321 | |
| (907) 442-7250 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 436 5th & Ted Stevens Way, Kotzebue, Alaska |
| Authorized Official Name and Position | Paul Hanson (ADMINISTRATOR) |
| Authorized Official Contact | 9074423321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 43 Kotzebue AK 99752-0043 Ph: (907) 442-3321 | 436 5th & Ted Stevens Way Kotzebue AK 99752 Ph: (907) 442-3321 |
| NPI Number | 1518160464 |
|---|---|
| Provider Enumeration Date | 06/07/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518160464 | NPI | - | NPPES |
| DDG111 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 234051 (Alaska) | Primary |