Healthcare Provider Details

I. General information

NPI: 1912919895
Provider Name (Legal Business Name): ALASKA ORAL & FACIAL SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SADLER WAY SUITE 202
FAIRBANKS AK
99701-3171
US

IV. Provider business mailing address

1275 SADLER WAY SUITE 202
FAIRBANKS AK
99701-3171
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-4101
  • Fax: 907-452-4102
Mailing address:
  • Phone: 907-452-4101
  • Fax: 907-452-4102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHEN H SUTLEY
Title or Position: ORAL SURGEON
Credential: D.D.S.
Phone: 907-452-4101