Provider Demographics
NPI:1891285433
Name:ALASKAN FAMILY DENTAL CENTER LLC
Entity Type:Organization
Organization Name:ALASKAN FAMILY DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:MULLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-376-0452
Mailing Address - Street 1:281 N MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7046
Mailing Address - Country:US
Mailing Address - Phone:907-376-0452
Mailing Address - Fax:907-376-0462
Practice Address - Street 1:281 N MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7046
Practice Address - Country:US
Practice Address - Phone:907-376-0452
Practice Address - Fax:907-376-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1072261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental