| Dental- Port Alsworth Clinic | |
|
1 Flight Line Rd Port Alsworth AK 99653-9801 | |
| (907) 781-2256 | |
| Not Available |
| Full Name | Dental- Port Alsworth Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1 Flight Line Rd, Port Alsworth, 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 |
|---|---|
| Dental- Port Alsworth Clinic Po Box 35151 Seattle WA 98124-5151 Ph: () - | Dental- Port Alsworth Clinic 1 Flight Line Rd Port Alsworth AK 99653-9801 Ph: (907) 781-2256 |
| NPI Number | 1114480167 |
|---|---|
| Provider Enumeration Date | 04/08/2019 |
| Last Update Date | 08/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114480167 | NPI | - | NPPES |
| 1695503 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |