Provider Demographics
NPI:1790205763
Name:MANN FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:MANN FAMILY DENTAL, LLC
Other - Org Name:MANN FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALANKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-903-6145
Mailing Address - Street 1:4641 E FRONTIER PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6044
Mailing Address - Country:US
Mailing Address - Phone:907-373-2227
Mailing Address - Fax:888-357-2588
Practice Address - Street 1:4641 FRONITER PLAZA DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-373-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1676113Medicaid