Healthcare Provider Details

I. General information

NPI: 1063710994
Provider Name (Legal Business Name): FAIRBANKS ORAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12810 GLEN ALPS RD
ANCHORAGE AK
99516-6956
US

IV. Provider business mailing address

114 MINNIE ST SUITE D
FAIRBANKS AK
99701-3006
US

V. Phone/Fax

Practice location:
  • Phone: 907-388-1386
  • Fax: 907-455-2010
Mailing address:
  • Phone: 907-455-1040
  • Fax: 907-455-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number164
License Number StateAK

VIII. Authorized Official

Name: DR. SARAH JANE SATOW
Title or Position: OWNER / PRESIDENT
Credential: DMD
Phone: 907-388-1386