Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Dental- Lifehouse Dental Clinic, Lifehouse Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHCENTRAL FOUNDATION
Authorized official
RONALD LEE OLSON (EXECUTIVE VICE PRESIDENT FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
11495 N. CALLISON STREET, SUTTON, AK 99674
(907) 631-7665
Mailing address
PO BOX 35151, SEATTLE, WA 98124-5151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20467
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1654481
—
AK
Enumeration date
09/08/2016
Last updated
08/31/2023
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