Organization
PREMIUM ASPECT DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS ALLEN LIEN D.D.S. (MANAGING MEMBER)
(907) 235-3618
Entity
Organization
Contact information
Practice address
345 STERLING HWY, SUITE 102A, HOMER, AK 99603-7820
(907) 235-3618
(907) 235-6849
Mailing address
345 STERLING HWY, SUITE 102A, HOMER, AK 99603-7820
(907) 235-3618
(907) 235-6849
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AA0649
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
663219
CLAIMS SUBMISSION ID
AK
05
—
DD06492
—
AK
Enumeration date
11/15/2006
Last updated
04/04/2013
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