Provider Demographics
NPI:1114632007
Name:IMPLANTS OF ALASKA LLC
Entity Type:Organization
Organization Name:IMPLANTS OF ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-360-8516
Mailing Address - Street 1:2805 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3800
Mailing Address - Country:US
Mailing Address - Phone:907-562-6456
Mailing Address - Fax:833-533-4921
Practice Address - Street 1:502 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3803
Practice Address - Country:US
Practice Address - Phone:907-360-8516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental