Organization
BORE TIDE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS S SERIE (PHYSICIAN ASSISTANT)
(907) 677-2990
Entity
Organization
Contact information
Practice address
22742 OBERG RD, CHUGIAK, AK 99567-5495
(907) 854-8452
(907) 222-4641
Mailing address
PO BOX 220685, ANCHORAGE, AK 99522-0685
(907) 677-2990
(907) 222-4641
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
633
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDA0081
—
AK
Enumeration date
02/18/2010
Last updated
02/18/2010
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