Organization
BLUE PHOENIX DENTAL LLC
Active
Other names
Aleutian Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SEAN MICHAEL DAVIS DDS (DENTIST)
(907) 545-1191
Entity
Organization
Contact information
Practice address
159 RIVERSIDE DRIVE, UNALASKA, AK 99685
(907) 545-1191
Mailing address
205 E DIMOND BLVD # 592, ANCHORAGE, AK 99515-1909
(907) 545-1191
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1663861
—
AK
05
—
1687307
—
AK
Enumeration date
11/10/2021
Last updated
11/10/2021
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