Provider Demographics
NPI:1952325193
Name:LAND, ALFRED M III (DMD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:M
Last Name:LAND
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10928 EAGLE RIVER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8038
Mailing Address - Country:US
Mailing Address - Phone:907-696-4987
Mailing Address - Fax:907-696-4991
Practice Address - Street 1:10928 EAGLE RIVER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8038
Practice Address - Country:US
Practice Address - Phone:907-696-4987
Practice Address - Fax:907-696-4991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6181122300000X
AK6621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice