Provider Demographics
NPI:1922579143
Name:ULAK, JANETTE CARMEN
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:CARMEN
Last Name:ULAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6229
Mailing Address - Fax:
Practice Address - Street 1:49 AIRPORT RD
Practice Address - Street 2:HOOPER BAY CLINIC
Practice Address - City:HOOPER BAY
Practice Address - State:AK
Practice Address - Zip Code:99604
Practice Address - Country:US
Practice Address - Phone:907-758-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK07-046-DHAT125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist