Provider Demographics
NPI:1194471672
Name:ALYESKA PEDIATRIC DENTISTRY, LLC
Entity type:Organization
Organization Name:ALYESKA PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EASTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-812-7861
Mailing Address - Street 1:3818 WESTMINSTER WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4834
Mailing Address - Country:US
Mailing Address - Phone:702-812-7861
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKE OTIS PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5226
Practice Address - Country:US
Practice Address - Phone:907-562-1003
Practice Address - Fax:907-562-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1730591298Medicaid