Provider Demographics
NPI:1508385253
Name:ALASKA CENTER FOR CLEFT AND CRANIOFACIAL SURGERY, LLC
Entity Type:Organization
Organization Name:ALASKA CENTER FOR CLEFT AND CRANIOFACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DASHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:907-222-5052
Mailing Address - Street 1:3909 ARTIC BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5769
Mailing Address - Country:US
Mailing Address - Phone:907-222-5052
Mailing Address - Fax:907-222-5051
Practice Address - Street 1:3909 ARTIC BLVD STE 404
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5769
Practice Address - Country:US
Practice Address - Phone:907-222-5052
Practice Address - Fax:907-222-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty