Organization
CAMAI DENTAL CLINIC LLC
Active
Other names
Dental Innovations
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY WADE LUCAS DDS (OWNER/PRACTITIONER)
(907) 357-5214
Entity
Organization
Contact information
Practice address
3161 E PALMER WASILLA HWY, STE 5, WASILLA, AK 99654-7271
(907) 357-5214
(907) 357-5213
Mailing address
3161 E PALMER WASILLA HWY, STE 5, WASILLA, AK 99654-7271
(907) 357-5214
(907) 357-5213
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
673
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003119
—
AK
Enumeration date
01/17/2017
Last updated
01/17/2017
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