| Southcentral Foundation | |
|
102 Fireweed Lane Newhalen AK 99606 | |
| (907) 571-1231 | |
| (907) 571-1551 |
| Full Name | Southcentral Foundation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 102 Fireweed Lane, Newhalen, Alaska |
| Authorized Official Name and Position | Kevin Gottlieb (VICE PRESIDENT) |
| Authorized Official Contact | 9073176070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southcentral Foundation Po Box 35151 Seattle WA 98124-5151 Ph: (907) 317-6070 | Southcentral Foundation 102 Fireweed Lane Newhalen AK 99606 Ph: (907) 571-1231 |
| NPI Number | 1578010476 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 09/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578010476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20467 (Alaska) | Primary |