Southcentral Foundation

NPI #1124603733 in Wasilla, Alaska

Provider Information

NPI Number
1124603733
Entity Type
Organization
Organization Name
Southcentral Foundation
Subpart
Yes (part of a larger organization)
Parent Organization
SOUTHCENTRAL FOUNDATION
Primary Specialty
Dentist - General Practice
Enumeration Date
Mar 15, 2021
Last Updated
Aug 31, 2023

Practice Location

Address
1001 S KNIK GOOSE BAY RD
State
Alaska
ZIP Code
99654-8083
Phone
(907) 631-7690

Authorized Official

Name
RONALD LEE OLSON
Title
EXECUTIVE VICE PRESIDENT FINANCE
Phone
(907) 729-4939

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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