Provider Demographics
NPI:1932664877
Name:ALASKA FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:ALASKA FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-562-0958
Mailing Address - Street 1:405 W 36TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5872
Mailing Address - Country:US
Mailing Address - Phone:907-562-0958
Mailing Address - Fax:907-562-6425
Practice Address - Street 1:405 W 36TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5872
Practice Address - Country:US
Practice Address - Phone:907-562-0958
Practice Address - Fax:907-562-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDO559Medicaid