Provider Demographics
NPI:1194163691
Name:DISCOVERY DENTAL, LLC
Entity type:Organization
Organization Name:DISCOVERY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARISEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-622-5437
Mailing Address - Street 1:12641 OLD GLENN HWY
Mailing Address - Street 2:STE 203
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7039
Mailing Address - Country:US
Mailing Address - Phone:907-622-5437
Mailing Address - Fax:
Practice Address - Street 1:12641 OLD GLENN HWY
Practice Address - Street 2:STE 203
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7039
Practice Address - Country:US
Practice Address - Phone:907-622-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9885841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty