Organization
KELLY MAIXNER DMD LLC DBA WEE CARE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTI FORREST (MANAGER)
(907) 373-6000
Entity
Organization
Contact information
Practice address
1001 E USA CIR STE B, WASILLA, AK 99654-7198
(907) 373-6000
(907) 357-6878
Mailing address
1001 E USA CIR STE B, WASILLA, AK 99654-7198
(907) 373-6000
(907) 357-6878
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1248
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003575
—
AK
Enumeration date
08/01/2018
Last updated
08/01/2018
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