Provider Demographics
NPI:1356677751
Name:ALASKA DENTAL OUTREACH CONSORTIUM
Entity type:Organization
Organization Name:ALASKA DENTAL OUTREACH CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TOWLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-563-3011
Mailing Address - Street 1:9170 JEWEL LAKE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5390
Mailing Address - Country:US
Mailing Address - Phone:907-563-3011
Mailing Address - Fax:907-563-3009
Practice Address - Street 1:9170 JEWEL LAKE RD STE 203
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5390
Practice Address - Country:US
Practice Address - Phone:907-563-3011
Practice Address - Fax:907-563-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty