Provider Demographics
NPI:1154581718
Name:ENGHIRST CORPORATION
Entity type:Organization
Organization Name:ENGHIRST CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGHIRST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-696-2875
Mailing Address - Street 1:11431 BUSINESS BLVD # 5
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7722
Mailing Address - Country:US
Mailing Address - Phone:907-696-2875
Mailing Address - Fax:907-696-2878
Practice Address - Street 1:11431 BUSINESS BLVD # 5
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7722
Practice Address - Country:US
Practice Address - Phone:907-696-2875
Practice Address - Fax:907-696-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1146261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental