| Minnie Street Children's Dentistry, Pc | |
|
114 Minnie St Ste B Fairbanks AK 99701-3000 | |
| (907) 308-2200 | |
| Not Available |
| Full Name | Minnie Street Children's Dentistry, Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 114 Minnie St Ste B, Fairbanks, Alaska |
| Authorized Official Name and Position | Gregory L Johnson (MEMBER) |
| Authorized Official Contact | 9074798844 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Minnie Street Children's Dentistry, Pc 114 Minnie St Ste B Fairbanks AK 99701-3000 Ph: (907) 308-2200 | Minnie Street Children's Dentistry, Pc 114 Minnie St Ste B Fairbanks AK 99701-3000 Ph: (907) 308-2200 |
| NPI Number | 1770250292 |
|---|---|
| Provider Enumeration Date | 08/24/2021 |
| Last Update Date | 08/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770250292 | NPI | - | NPPES |
| UNKNOWN | Other | AK | UNKNOWN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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