Provider Demographics
NPI:1093213167
Name:KODIAK AREA NATIVE ASSOCIATION
Entity Type:Organization
Organization Name:KODIAK AREA NATIVE ASSOCIATION
Other - Org Name:FAMILY DENTISTRY OF KODIAK
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PFEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-486-9800
Mailing Address - Street 1:3449 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6952
Mailing Address - Country:US
Mailing Address - Phone:907-486-9880
Mailing Address - Fax:907-486-9896
Practice Address - Street 1:1317 MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6411
Practice Address - Country:US
Practice Address - Phone:907-486-3291
Practice Address - Fax:907-486-9896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KODIAK AREA NATIVE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental