Provider Demographics
NPI:1629374129
Name:ALASKA DENTISTRY FOR KIDS, LLC
Entity Type:Organization
Organization Name:ALASKA DENTISTRY FOR KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:COPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-274-2525
Mailing Address - Street 1:880 N ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3276
Mailing Address - Country:US
Mailing Address - Phone:907-274-2525
Mailing Address - Fax:907-277-4725
Practice Address - Street 1:880 N ST STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3276
Practice Address - Country:US
Practice Address - Phone:907-274-2525
Practice Address - Fax:907-277-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK13291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAK1329OtherAK LICENSE