| Four Corners Dental Group | |
|
4001 Geist Rd Ste 3 Fairbanks AK 99709-3569 | |
| (907) 479-7771 | |
| (907) 479-7772 |
| Full Name | Four Corners Dental Group |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4001 Geist Rd Ste 3, Fairbanks, Alaska |
| Authorized Official Name and Position | Pete B. Higgins (MANAGING MEMBER) |
| Authorized Official Contact | 9074797771 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Corners Dental Group 4001 Geist Rd Ste 3 Fairbanks AK 99709-3569 Ph: (907) 479-7771 | Four Corners Dental Group 4001 Geist Rd Ste 3 Fairbanks AK 99709-3569 Ph: (907) 479-7771 |
| NPI Number | 1609055029 |
|---|---|
| Provider Enumeration Date | 11/01/2007 |
| Last Update Date | 11/01/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609055029 | NPI | - | NPPES |
| DD10122 | Medicaid | AK | |
| 1568540946 | Other | INDIVIDUAL NPI | |
| DD10121 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 1012 (Alaska) | Primary |
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