Provider Demographics
NPI:1851601967
Name:ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
Entity Type:Organization
Organization Name:ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SITE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-729-5602
Mailing Address - Street 1:4000 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5909
Mailing Address - Country:US
Mailing Address - Phone:907-729-5600
Mailing Address - Fax:907-729-5610
Practice Address - Street 1:610 AKIACHUK DR.
Practice Address - Street 2:SUITE 208
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-0980
Practice Address - Fax:907-543-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty