Provider Demographics
NPI:1619190980
Name:ALASKA DENTAL CENTER
Entity Type:Organization
Organization Name:ALASKA DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MPH, DDS
Authorized Official - Phone:907-337-9434
Mailing Address - Street 1:322 MULDOON RD
Mailing Address - Street 2:C
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1504
Mailing Address - Country:US
Mailing Address - Phone:907-337-9434
Mailing Address - Fax:907-333-5112
Practice Address - Street 1:322 MULDOON RD
Practice Address - Street 2:C
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1504
Practice Address - Country:US
Practice Address - Phone:907-337-9434
Practice Address - Fax:907-333-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK05821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty