| North Star Children's Dentistry, Pc | |
|
114 Minnie St Suite A Fairbanks AK 99701-3006 | |
| (907) 452-4509 | |
| (907) 457-4509 |
| Full Name | North Star Children's Dentistry, Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 114 Minnie St, Fairbanks, Alaska |
| Authorized Official Name and Position | Gregory L. Johnson (PRESIDENT) |
| Authorized Official Contact | 9074524509 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Star Children's Dentistry, Pc 114 Minnie St Suite A Fairbanks AK 99701-3006 Ph: (907) 452-4509 | North Star Children's Dentistry, Pc 114 Minnie St Suite A Fairbanks AK 99701-3006 Ph: (907) 452-4509 |
| NPI Number | 1154489938 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 05/08/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154489938 | NPI | - | NPPES |
| DD0657 | Medicaid | AK | |
| DD55881 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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