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Organization
PEDIATRIC DENTISTRY OF ALASKA
Active
Organization
PEDIATRIC DENTISTRY OF ALASKA
Active
Other names
Pediatric Dentistry of Alaska
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER DUANE BECK DDA (OWNER/PRESIDENT)
(907) 373-8684
Entity
Organization
Contact information
Practice address
3470 E MERIDIAN PARK LOOP, WASILLA, AK 99654
(907) 373-8684
(907) 373-8465
Mailing address
3470 E MERIDIAN PARK LOOP, WASILLA, AK 99654
(907) 373-8684
(907) 373-8465
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
924
AK
261QD0000X
Dental Clinic/Center
Primary
924
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003811
—
AK
05
—
1583802
—
AK
Enumeration date
11/04/2008
Last updated
09/12/2018
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