Provider Demographics
NPI:1922310432
Name:AURORA DENTAL CLINIC, LLC
Entity Type:Organization
Organization Name:AURORA DENTAL CLINIC, LLC
Other - Org Name:AURORA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEL JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDEKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-376-8400
Mailing Address - Street 1:4501 E SNIDER DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7604
Mailing Address - Country:US
Mailing Address - Phone:907-376-8400
Mailing Address - Fax:907-676-8402
Practice Address - Street 1:4501 E SNIDER DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7604
Practice Address - Country:US
Practice Address - Phone:907-376-8400
Practice Address - Fax:907-376-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty