Dental- Valley Dental Clinic

LBN: Southcentral Foundation
Dental- Valley Dental Clinic is an health care organization with primary practice located at 1001 S Knik Goose Bay Rd , Wasilla AK 99654-8083. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty. Southcentral Foundation can be contacted via phone (907) 631-7690, or through Olson, Ronald Lee via phone (907) 729-4939.

Contact Information

Primary practice address
1001 S Knik Goose Bay Rd Wasilla AK 99654-8083
Phone: (907) 631-7690
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Olson, Ronald Lee
Phone: (907) 729-4939

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X

Profile Details

NPI number 1124603733
LBN Legal business name Southcentral Foundation
DBA Doing business as Dental- Valley Dental Clinic
Authorized official Olson, Ronald Lee
Entity Organization
Organization subpart 1 Yes
Enumeration date Mar 15th, 2021
Last updated Aug 31st, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1124603733 NPPES
Alaska MEDICAID 1584443

Popular Providers