Organization
INTERIOR COMMUNITY HEALTH CENTER DENTAL PROG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL KILGORE (EXECUTIVE DIRECTOR)
(907) 455-4567
Entity
Organization
Contact information
Practice address
1606 23RD AVE, FAIRBANKS, AK 99701-6407
(907) 455-4567
Mailing address
1606 23RD AVE, FAIRBANKS, AK 99701-6407
(907) 455-4567
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02-1810
PROVIDER NUMBER
AK
Enumeration date
04/18/2007
Last updated
08/22/2020
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