Provider Demographics
NPI:1093121279
Name:JUST AND MISHLER DENTAL GROUP LLC
Entity Type:Organization
Organization Name:JUST AND MISHLER DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JUST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-337-0304
Mailing Address - Street 1:6611 DEBARR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1706
Mailing Address - Country:US
Mailing Address - Phone:907-337-0304
Mailing Address - Fax:907-929-2179
Practice Address - Street 1:6611 DEBARR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1706
Practice Address - Country:US
Practice Address - Phone:907-337-0304
Practice Address - Fax:907-929-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1007401261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental