Provider Demographics
NPI:1376887026
Name:CHINOOK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CHINOOK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SYMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-272-8422
Mailing Address - Street 1:2401 E 42ND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5228
Mailing Address - Country:US
Mailing Address - Phone:907-272-8422
Mailing Address - Fax:907-277-9226
Practice Address - Street 1:2401 E 42ND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5228
Practice Address - Country:US
Practice Address - Phone:907-272-8422
Practice Address - Fax:907-277-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty