Provider Demographics
NPI: | 1477765394 |
---|---|
Name: | DOUGLAS J. LUITEN, D.M.D., P.C. |
Entity Type: | Organization |
Organization Name: | DOUGLAS J. LUITEN, D.M.D., P.C. |
Other - Org Name: | NORTH PACIFIC ENDODONTICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | BUSINESS MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BARBARA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LUITEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 907-561-0675 |
Mailing Address - Street 1: | 4001 LAUREL STREET |
Mailing Address - Street 2: | SUITE 208 |
Mailing Address - City: | ANCHORAGE |
Mailing Address - State: | AK |
Mailing Address - Zip Code: | 99508 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 907-561-0675 |
Mailing Address - Fax: | 907-562-1563 |
Practice Address - Street 1: | 4001 LAUREL STREET |
Practice Address - Street 2: | SUITE 208 |
Practice Address - City: | ANCHORAGE |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99508 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-561-0675 |
Practice Address - Fax: | 907-562-1563 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-04 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223E0200X | Dental Providers | Dentist | Endodontics | Group - Single Specialty |