Provider Demographics
NPI:1447743018
Name:NAKNEK CAMAI DENTAL CLINIC LLC
Entity Type:Organization
Organization Name:NAKNEK CAMAI DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-246-6157
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:NAKNEK
Mailing Address - State:AK
Mailing Address - Zip Code:99633-0117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:NAKNEK
Practice Address - State:AK
Practice Address - Zip Code:99633
Practice Address - Country:US
Practice Address - Phone:907-246-6157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental