Provider Demographics
NPI:1215437165
Name:ARCTIC ORAL SURGERY, LLC
Entity type:Organization
Organization Name:ARCTIC ORAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RIOS-ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-726-5600
Mailing Address - Street 1:12641 OLD GLENN HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7040
Mailing Address - Country:US
Mailing Address - Phone:907-726-5600
Mailing Address - Fax:907-726-5602
Practice Address - Street 1:12641 OLD GLENN HWY STE 103
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-726-5600
Practice Address - Fax:907-726-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty