Organization
KODIAK ISLAND FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TABITHA LEIVA (OFFICE MANAGER)
(907) 481-3567
Entity
Organization
Contact information
Practice address
204 E REZANOF DR STE 201, KODIAK, AK 99615-6379
(907) 481-3567
Mailing address
204 E REZANOF DR STE 201, KODIAK, AK 99615-6379
(907) 481-3567
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326421850
—
AK
05
—
1437243326
—
AK
05
—
1639787021
—
AK
Enumeration date
07/08/2021
Last updated
07/08/2021
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