Provider Demographics
NPI:1770829988
Name:AURORA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:AURORA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:LYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-258-7060
Mailing Address - Street 1:121 W FIREWEED LN
Mailing Address - Street 2:STE 280
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2053
Mailing Address - Country:US
Mailing Address - Phone:907-258-7060
Mailing Address - Fax:907-222-1665
Practice Address - Street 1:121 W FIREWEED LN
Practice Address - Street 2:STE 280
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2053
Practice Address - Country:US
Practice Address - Phone:907-258-7060
Practice Address - Fax:907-222-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1293261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental