Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Dental- Ambassador Drive 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
4115 AMBASSADOR DR STE H210, ANCHORAGE, AK 99508-5928
(907) 729-2000
Mailing address
PO BOX 35151, SEATTLE, WA 98124-5151
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1725227
—
AK
Enumeration date
09/28/2021
Last updated
04/01/2026
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