Organization
49TH STATE FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN DONOHUE DDS (OWNER/MEMBER)
(907) 561-5154
Entity
Organization
Contact information
Practice address
10998 OMALLEY CENTRE DR STE A, ANCHORAGE, AK 99515-3168
(907) 561-5154
(907) 561-2253
Mailing address
10998 OMALLEY CENTRE DR STE A, ANCHORAGE, AK 99515-3168
(907) 561-5154
(907) 561-2253
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114268711
TYPE 1 NPI
—
Enumeration date
02/16/2021
Last updated
02/16/2021
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