Provider Demographics
NPI:1942865761
Name:CHUGACH DENTAL, LLC
Entity Type:Organization
Organization Name:CHUGACH DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-868-3000
Mailing Address - Street 1:9138 ARLON ST STE B3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3876
Mailing Address - Country:US
Mailing Address - Phone:907-868-3000
Mailing Address - Fax:907-802-2935
Practice Address - Street 1:9138 ARLON ST STE B3
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3876
Practice Address - Country:US
Practice Address - Phone:907-868-3000
Practice Address - Fax:907-802-2935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental