Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Dental- Eklutna 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
26341 EKLUTNA VILLAGE RD, CHUGIAK, AK 99567-5148
(907) 688-6031
Mailing address
PO BOX 35151, SEATTLE, WA 98124-5151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1690189
—
AK
Enumeration date
10/30/2018
Last updated
10/10/2023
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