Provider Demographics
NPI:1225404320
Name:CLEAR DENTAL, LLC
Entity Type:Organization
Organization Name:CLEAR DENTAL, LLC
Other - Org Name:CLEAR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MARKETING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-333-6666
Mailing Address - Street 1:2906 BONIFACE PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3132
Mailing Address - Country:US
Mailing Address - Phone:907-333-0696
Mailing Address - Fax:907-338-6654
Practice Address - Street 1:2906 BONIFACE PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3132
Practice Address - Country:US
Practice Address - Phone:907-333-0696
Practice Address - Fax:907-338-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty