Organization
FOUR CORNERS DENTAL GROUP FAIRBANKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE D RHOTON (DENTIST)
(907) 479-7771
Entity
Organization
Contact information
Practice address
3487 AIRPORT WAY, FAIRBANKS, AK 99709-4761
(907) 479-7771
(907) 479-7772
Mailing address
3487 AIRPORT WAY, FAIRBANKS, AK 99709-4761
(907) 479-7771
(907) 479-7772
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1262
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD0143
—
AK
Enumeration date
08/09/2013
Last updated
08/09/2013
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