Basic Information
| Provider Information | |||||||||
| NPI: | 1063863215 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ARCTIC FAMILY DENTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3909 ARCTIC BLVD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995035770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073392331 | ||||||||
| FaxNumber: | 9073392332 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 ARCTIC BLVD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995035770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073392331 | ||||||||
| FaxNumber: | 9073392332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2016 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | MASSEY | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | BEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9073392331 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.M.D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 1026 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.