| Southcentral Foundation | |
| 
					101 Airport Road Iliamna AK 99606  | |
| (907) 571-1818 | |
| Not Available | 
| Full Name | Southcentral Foundation | 
|---|---|
| Speciality | Clinic/center - Dental | 
| Location | 101 Airport Road, Iliamna, Alaska | 
| Authorized Official Name and Position | Ronald Lee Olson (EXECUTIVE VICE PRESIDENT FINANCE) | 
| Authorized Official Contact | 9077294939 | 
| 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: () -  | Southcentral Foundation 101 Airport Road Iliamna AK 99606 Ph: (907) 571-1818  | 
| NPI Number | 1750961918 | 
|---|---|
| Provider Enumeration Date | 04/12/2021 | 
| Last Update Date | 09/15/2023 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1750961918 | NPI | - | NPPES | 
| 1654555 | Medicaid | AK | 
Southcentral Foundation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 Airport Road, Iliamna, AK 99606 Phone: 907-571-1818  |