Provider Demographics
NPI:1114713625
Name:ERIC NANCE AK
Entity type:Organization
Organization Name:ERIC NANCE AK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-369-0012
Mailing Address - Street 1:1923 E 475 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2634
Mailing Address - Country:US
Mailing Address - Phone:801-369-0012
Mailing Address - Fax:
Practice Address - Street 1:130 CARLANNA LAKE RD
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5669
Practice Address - Country:US
Practice Address - Phone:801-369-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty