Individual
TYLER KAYLE LONGFELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
104 S BINKLEY ST STE A, SOLDOTNA, AK 99669-8038
(907) 262-8834
Mailing address
288 GERANIUM RD, SOLDOTNA, AK 99669-7968
(801) 791-1760
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
182292
AK
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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