Provider Demographics
NPI:1912919895
Name:ALASKA ORAL & FACIAL SURGERY CENTER INC
Entity Type:Organization
Organization Name:ALASKA ORAL & FACIAL SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-452-4101
Mailing Address - Street 1:1275 SADLER WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3171
Mailing Address - Country:US
Mailing Address - Phone:907-452-4101
Mailing Address - Fax:907-452-4102
Practice Address - Street 1:1275 SADLER WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3171
Practice Address - Country:US
Practice Address - Phone:907-452-4101
Practice Address - Fax:907-452-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty