| Copper River Native Association | |
|
Glenn Hwy. 187 Mp Glennallen AK 99588-0744 | |
| (907) 822-3113 | |
| (907) 822-4045 |
| Full Name | Copper River Native Association |
|---|---|
| Speciality | Dentist |
| Location | Glenn Hwy. 187 Mp, Glennallen, Alaska |
| Authorized Official Name and Position | Arlene Dilts Jackson (CEO) |
| Authorized Official Contact | 9078225241 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Copper River Native Association 187 Glenn Highway Glennallen AK 99588-0744 Ph: (907) 822-3113 | Copper River Native Association Glenn Hwy. 187 Mp Glennallen AK 99588-0744 Ph: (907) 822-3113 |
| NPI Number | 1306987532 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306987532 | NPI | - | NPPES |
| DD1001 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 36087 (Alaska) | Primary |
Kevin Brent Shedlock, Dds, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: Mile 187 Glenn Highway, Glennallen, AK 99588 Phone: 907-320-0455 |