Healthcare Provider Details

I. General information

NPI: 1275462608
Provider Name (Legal Business Name): KENYAN DEXTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16331 HERITAGE PL STE 101
EAGLE RIVER AK
99577-7753
US

IV. Provider business mailing address

9529 NOAK CIR
EAGLE RIVER AK
99577-8515
US

V. Phone/Fax

Practice location:
  • Phone: 907-350-8893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: