| Maniilaq Association | |
|
436 5th & Ted Stevens Way Kotzebue AK 99752 | |
| (907) 442-3321 | |
| (907) 442-7250 |
| Full Name | Maniilaq Association |
|---|---|
| Speciality | Dentist |
| Location | 436 5th & Ted Stevens Way, Kotzebue, Alaska |
| Authorized Official Name and Position | Paul Hanson (MEDICAL STAFF SERVICES) |
| Authorized Official Contact | 9074423321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maniilaq Association Po Box 43 Kotzebue AK 99752-0043 Ph: (907) 442-3321 | Maniilaq Association 436 5th & Ted Stevens Way Kotzebue AK 99752 Ph: (907) 442-3321 |
| NPI Number | 1003010042 |
|---|---|
| Provider Enumeration Date | 06/13/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003010042 | NPI | - | NPPES |
| DDG111 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 234051 (Alaska) | Primary |
Maniilaq Association Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 436 5th & Ted Stevens Way, Kotzebue, AK 99752 Phone: 907-442-3321 Fax: 907-442-7250 | |
Maniilaq Association Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 436 5th & Ted Stevens Way, Kotzebue, AK 99752 Phone: 907-442-3321 Fax: 907-442-7250 |