Southcentral Foundation

NPI #1225618481 in Anchorage, Alaska

Provider Information

NPI Number: 1225618481
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: Apr 12, 2021
Last Updated: Aug 31, 2023

Practice Location

Address: 4441 DIPLOMACY DR
City: Anchorage
State: Alaska
ZIP Code: 99508-5910
Phone: (907) 729-2000

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Pediatric Dentistry — Pediatric Dentistry	1223P0221X
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X
Dentist - General Practice — General Practice	1223G0001X	Primary

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