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Organization

PEDIATRIC DENTISTRY OF ALASKA

Active
Other names
Pediatric Dentistry of Alaska
Organization subpart
No

Provider details

NPI number
Authorized official
ROGER DUANE BECK DDA (OWNER/PRESIDENT)
(907) 373-8684
Entity
Organization

Contact information

Practice address
3470 E MERIDIAN PARK LOOP, WASILLA, AK 99654
(907) 373-8684
(907) 373-8465
Mailing address
3470 E MERIDIAN PARK LOOP, WASILLA, AK 99654
(907) 373-8684
(907) 373-8465

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
924
AK
261QD0000X
Dental Clinic/Center
Primary
924
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1003811
AK
05
1583802
AK
Enumeration date
11/04/2008
Last updated
09/12/2018
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