Organization Name: | LAKEVIEW DENTAL ASSOCIATES |
NPI Number: | 1023294113 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEAN KINGSLIEN (OFFICE MANAGER) |
Mailing Address: | 851 E Westpoint Dr Ste 112 Wasilla |
State: | AK US |
Postal Code: | 996547183 |
Phone Number: | 9073764415 |
Fax Number: | |
NPI Enumeration Date: | 01/18/2008 |
NPI Last Update Date: | 01/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 348 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |