Provider Demographics
NPI:1376828012
Name:ALCAN DENTAL GROUP
Entity Type:Organization
Organization Name:ALCAN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-562-4774
Mailing Address - Street 1:2819 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3837
Mailing Address - Country:US
Mailing Address - Phone:907-562-4774
Mailing Address - Fax:907-561-2714
Practice Address - Street 1:2819 DAWSON ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3837
Practice Address - Country:US
Practice Address - Phone:907-562-4774
Practice Address - Fax:907-561-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty