Provider Demographics
NPI:1972989374
Name:UAA DENTAL CLINIC
Entity Type:Organization
Organization Name:UAA DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-786-6932
Mailing Address - Street 1:3211 PROVIDENCE DR
Mailing Address - Street 2:ALLIED HEALTH SCIENCE BLDG # 131
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4614
Mailing Address - Country:US
Mailing Address - Phone:907-786-1243
Mailing Address - Fax:
Practice Address - Street 1:3211 PROVIDENCE DR
Practice Address - Street 2:ALLIED HEALTH SCIENCE BLDG # 131
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4614
Practice Address - Country:US
Practice Address - Phone:907-786-1243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)