Provider Demographics
NPI:1467726463
Name:HARBOR VIEW DENTAL CARE, LLC
Entity Type:Organization
Organization Name:HARBOR VIEW DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-602-4124
Mailing Address - Street 1:712 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1574
Mailing Address - Country:US
Mailing Address - Phone:907-586-1188
Mailing Address - Fax:907-586-4408
Practice Address - Street 1:712 W 12TH ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1574
Practice Address - Country:US
Practice Address - Phone:907-586-1188
Practice Address - Fax:907-586-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0082Medicaid