Provider Demographics
NPI:1821138132
Name:DR. ELDON DEKAY, P.C.
Entity Type:Organization
Organization Name:DR. ELDON DEKAY, P.C.
Other - Org Name:EAGLE RIVER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:907-694-3555
Mailing Address - Street 1:16635 CENTERFIELD DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7719
Mailing Address - Country:US
Mailing Address - Phone:907-694-3555
Mailing Address - Fax:907-694-3320
Practice Address - Street 1:16635 CENTERFIELD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7719
Practice Address - Country:US
Practice Address - Phone:907-694-3555
Practice Address - Fax:907-694-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD09151Medicaid