Provider Demographics
NPI:1326580002
Name:DENALI DENTAL CARE
Entity Type:Organization
Organization Name:DENALI DENTAL CARE
Other - Org Name:EXCELLENCE IN DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-274-7691
Mailing Address - Street 1:625 E 34TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4154
Mailing Address - Country:US
Mailing Address - Phone:907-274-7691
Mailing Address - Fax:907-277-6142
Practice Address - Street 1:625 E 34TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4154
Practice Address - Country:US
Practice Address - Phone:907-274-7691
Practice Address - Fax:907-277-6142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELLENCE IN DENTISTRY PUEBLO ONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10691305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization