1821333790 NPI number — DARIAN MCL ERIK PRIMARY DENTAL HEALT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821333790 NPI number — DARIAN MCL ERIK PRIMARY DENTAL HEALT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERIK
Provider First Name:
DARIAN
Provider Middle Name:
MCL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PRIMARY DENTAL HEALT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821333790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 528
Provider Second Line Business Mailing Address:
YKHC
Provider Business Mailing Address City Name:
BETHEL
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99559-0528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-543-6229
Provider Business Mailing Address Fax Number:
907-543-6393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 WEST HOUSING ROAD
Provider Second Line Business Practice Location Address:
YKHC CHEFORNAK CLINIC
Provider Business Practice Location Address City Name:
CHEFORNAK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99561-0049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-867-8922
Provider Business Practice Location Address Fax Number:
907-867-8717
Provider Enumeration Date:
12/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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