Basic Information
| Provider Information | |||||||||
| NPI: | 1538432828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURAT | ||||||||
| FirstName: | CONAN | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DHAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 528 | ||||||||
| Address2: | 827 CHIEF EDDIE HOFFMAN HWY | ||||||||
| City: | BETHEL | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995590528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075436000 | ||||||||
| FaxNumber: | 9075436393 | ||||||||
| Practice Location | |||||||||
| Address1: | 269 MORGAN'S ROAD | ||||||||
| Address2: | |||||||||
| City: | ANIAK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995570269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076754556 | ||||||||
| FaxNumber: | 9076754591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2012 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 125J00000X | 05-017-DHAT | AK | Y | Dental Providers | Dental Therapist |
No ID Information.