Organization
SOUTHEAST DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTEN J SCHULTZ D.D.S. (DENTIST VICE PRESIDENT)
(907) 586-9885
Entity
Organization
Contact information
Practice address
2220 DUNN ST, JUNEAU, AK 99801-1430
(907) 586-9885
(907) 586-1849
Mailing address
2220 DUNN ST, JUNEAU, AK 99801-9304
(907) 586-9885
(907) 586-1849
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7113
CO
122300000X
Dentist
7435
CO
122300000X
Dentist
Primary
963
AK
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
961
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
963
STATE OF ALASKA
AK
05
—
DDO961
—
AK
Enumeration date
04/06/2007
Last updated
02/04/2014
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