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24091 W Long Lake Rd Willow AK 99688-0519 | |
(907) 733-2273 | |
(907) 733-1735 |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 24091 W Long Lake Rd, Willow, Alaska |
Authorized Official Name and Position | Amanda Simpson (CREDENTAILING SPECIALIST) |
Authorized Official Contact | 9077332273 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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24091 W Long Lake Road Willow AK 99688-9999 Ph: () - | 24091 W Long Lake Rd Willow AK 99688-0519 Ph: (907) 733-2273 |
NPI Number | 1528463304 |
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Provider Enumeration Date | 10/23/2014 |
Last Update Date | 12/03/2024 |
Identifier | Type | State | Issuer |
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1528463304 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | 77895 (Alaska) | Primary |