Basic Information
| Provider Information | |||||||||
| NPI: | 1740629344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERGIE-SHAVINGS | ||||||||
| FirstName: | XENIA | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PRIMARY DENTAL HEALT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43 | ||||||||
| Address2: | |||||||||
| City: | MEKORYUK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078278111 | ||||||||
| FaxNumber: | 9078278351 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 CHASE ROAD | ||||||||
| Address2: | |||||||||
| City: | MEKORYUK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078278111 | ||||||||
| FaxNumber: | 9078278351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.