Provider Demographics
NPI:1225373947
Name:FAIRBANKS FAMILY DENTAL CARE INC
Entity Type:Organization
Organization Name:FAIRBANKS FAMILY DENTAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-452-8296
Mailing Address - Street 1:515 7TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4933
Mailing Address - Country:US
Mailing Address - Phone:907-452-8296
Mailing Address - Fax:
Practice Address - Street 1:515 7TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4933
Practice Address - Country:US
Practice Address - Phone:907-452-8296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0027Medicaid
AKDD0085Medicaid