Individual
JACK B DUCLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S, M.S.
Contact information
Practice address
1836 W NORTHERN LIGHTS BLVD, ANCHORAGE, AK 99517-3342
(907) 272-3200
Mailing address
1836 W NORTHERN LIGHTS BLVD, ANCHORAGE, AK 99517-3342
(907) 272-3200
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
871
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD0871
—
AK
Enumeration date
04/26/2007
Last updated
07/08/2007
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