Healthcare Provider Details

I. General information

NPI: 1831646447
Provider Name (Legal Business Name): SADIE M GREEN DHAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SADIE GREEN DHAT

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559-0304
US

IV. Provider business mailing address

PO BOX 304
HOOPER BAY AK
99604-0304
US

V. Phone/Fax

Practice location:
  • Phone: 907-545-9022
  • Fax:
Mailing address:
  • Phone: 907-545-9022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number16-136-DHAT
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: