| Petersburg Dental, Inc. | |
|
806 S. Nordic Dr. Petersburg AK 99833-0469 | |
| (907) 772-9246 | |
| (907) 772-9278 |
| Full Name | Petersburg Dental, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 806 S. Nordic Dr., Petersburg, Alaska |
| Authorized Official Name and Position | Jay Lister (DDS/PRESIDENT) |
| Authorized Official Contact | 9077729246 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Petersburg Dental, Inc. Po Box 469 Petersburg AK 99833-0469 Ph: (907) 772-9246 | Petersburg Dental, Inc. 806 S. Nordic Dr. Petersburg AK 99833-0469 Ph: (907) 772-9246 |
| NPI Number | 1932543345 |
|---|---|
| Provider Enumeration Date | 04/29/2013 |
| Last Update Date | 04/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932543345 | NPI | - | NPPES |
| DD54042 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 1096 (Alaska) | Primary |
Southeast Alaska Regional Health Consortium Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 W Excel, Petersburg, AK 99833 Phone: 907-772-3320 |