Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Dental- Fireweed Dental Clinic ( Eaglesoft & Dolph, Dental- Village Dental Clinic ( Eaglesoft & Dolphi, Dental- ANMC Dental Clinic (Eaglesoft & Dolphin)
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHCENTRAL FOUNDATION
Authorized official
RONALD LEE OLSON (EXECUTIVE VICE PRESIDENT FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
4341 TUDOR CENTRE DR, ANCHORAGE, AK 99508-5904
(907) 729-2000
Mailing address
PO BOX 35151, SEATTLE, WA 98124-5151
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003875
—
AK
05
—
1580817
—
AK
05
—
1636631
—
AK
Enumeration date
02/08/2007
Last updated
09/18/2023
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