Organization
SOUTHCENTRAL FOUNDATION
Active
Other names
NEWHALEN DENTAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN GOTTLIEB DDS (VICE PRESIDENT)
(907) 317-6070
Entity
Organization
Contact information
Practice address
102 FIREWEED LANE, NEWHALEN, AK 99606
(907) 571-1231
(907) 571-1551
Mailing address
PO BOX 35151, SEATTLE, WA 98124-5151
(907) 317-6070
(907) 729-5178
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20467
AK
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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