Provider Demographics
NPI:1194360487
Name:CHENA DENTAL CARE LLC
Entity Type:Organization
Organization Name:CHENA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HADFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-488-0861
Mailing Address - Street 1:2933 HORSESHOE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6139
Mailing Address - Country:US
Mailing Address - Phone:907-488-0861
Mailing Address - Fax:907-488-3141
Practice Address - Street 1:2933 HORSESHOE WAY
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-6139
Practice Address - Country:US
Practice Address - Phone:907-488-0861
Practice Address - Fax:907-488-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1811215601Medicaid
AK1174695803Medicaid