Organization
PETERSBURG DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY LISTER (DDS/PRESIDENT)
(907) 772-9246
Entity
Organization
Contact information
Practice address
806 S. NORDIC DR., PETERSBURG, AK 99833-0469
(907) 772-9246
(907) 772-9278
Mailing address
PO BOX 469, PETERSBURG, AK 99833-0469
(907) 772-9246
(907) 772-9278
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1096
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD54042
—
AK
Enumeration date
04/29/2013
Last updated
04/29/2013
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