Provider Demographics
NPI:1245456755
Name:GENERAL FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:GENERAL FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURTCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-745-3600
Mailing Address - Street 1:557 S ALASKA ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6341
Mailing Address - Country:US
Mailing Address - Phone:907-745-3600
Mailing Address - Fax:907-745-3612
Practice Address - Street 1:557 S ALASKA ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6341
Practice Address - Country:US
Practice Address - Phone:907-745-3600
Practice Address - Fax:907-745-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty