Provider Demographics
NPI:1194062364
Name:ALASKA DENTAL ARTS LLC
Entity type:Organization
Organization Name:ALASKA DENTAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEUFFELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-248-7275
Mailing Address - Street 1:110 E SWANSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7024
Mailing Address - Country:US
Mailing Address - Phone:907-376-5207
Mailing Address - Fax:
Practice Address - Street 1:110 E SWANSON AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7024
Practice Address - Country:US
Practice Address - Phone:907-376-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty