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?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty