Healthcare Provider Details

I. General information

NPI: 1528922010
Provider Name (Legal Business Name): SHAUN ROBISON DHAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559
US

IV. Provider business mailing address

PO BOX 3427
BETHEL AK
99559-3427
US

V. Phone/Fax

Practice location:
  • Phone: 907-545-6928
  • Fax:
Mailing address:
  • Phone: 725-599-2183
  • Fax: 725-599-2183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number25-00633-DHAT
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: