Organization
YUKON KUSKOKWIM HEALTH CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENE PELTOLA (CEO)
(907) 543-6020
Entity
Organization
Contact information
Practice address
829 CHIEF EDDIE HOFFMAN HWY, SUITE 340, BETHEL, AK 99559
(907) 543-6000
(907) 543-6117
Mailing address
PO BOX 528, BETHEL, AK 99559-0528
(907) 543-6000
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0157
—
AK
05
—
GR0188
—
AK
05
—
GR0190
—
AK
Enumeration date
04/13/2007
Last updated
03/03/2008
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