Organization
FAIRBANKS ORTHODONTIC GROUP A PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALT BABULA DMD MSCO (PRESIDENT ORTHODONTIST)
(907) 452-2939
Entity
Organization
Contact information
Practice address
1919 LATHROP ST, SUITE 102, FAIRBANKS, AK 99701
(907) 452-2939
(907) 451-7330
Mailing address
1919 LATHROP ST, SUITE 102, FAIRBANKS, AK 99701
(907) 452-2939
(907) 451-7330
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
AK330
AK
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
AK9
AK
Other
Enumeration date
11/29/2006
Last updated
08/07/2013
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