Provider Demographics
NPI:1962726364
Name:SOUTHCENTRAL FOUNDATION DENTAL DHAT
Entity type:Organization
Organization Name:SOUTHCENTRAL FOUNDATION DENTAL DHAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER- DENTAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-317-6070
Mailing Address - Street 1:PO BOX 196320
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99519-6320
Mailing Address - Country:US
Mailing Address - Phone:907-317-6070
Mailing Address - Fax:806-794-1919
Practice Address - Street 1:4341 TUDOR CENTRE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-317-6070
Practice Address - Fax:806-794-1919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHCENTRAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental