Provider Demographics
NPI:1508362161
Name:PHILIP J LATTEIER DDS LLC
Entity Type:Organization
Organization Name:PHILIP J LATTEIER DDS LLC
Other - Org Name:ALASKA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:LATTEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-562-6648
Mailing Address - Street 1:3340 PROVIDENCE DR STE 560
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3340 PROVIDENCE DR STE 560
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4643
Practice Address - Country:US
Practice Address - Phone:907-562-6648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK128215261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental