Provider Demographics
NPI:1871003863
Name:CHUN PIU MAN, INC.
Entity Type:Organization
Organization Name:CHUN PIU MAN, INC.
Other - Org Name:EAGLE RIVER SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUN PIU
Authorized Official - Middle Name:
Authorized Official - Last Name:MAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-693-2875
Mailing Address - Street 1:8840 OLD SEWARD HIGHWAY, #F
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2000
Mailing Address - Country:US
Mailing Address - Phone:907-333-6666
Mailing Address - Fax:907-333-3390
Practice Address - Street 1:11431 BUSINESS BLVD., STE
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7754
Practice Address - Country:US
Practice Address - Phone:907-696-2875
Practice Address - Fax:907-333-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1054541223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1740685478Medicaid