Individual
TAYLOR CASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3406 ALDER AVE, FORT WAINWRIGHT, AK 99703
(907) 353-2917
Mailing address
PO BOX 60434, FAIRBANKS, AK 99706-0434
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11831305-9922
UT
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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