Healthcare Provider Details

I. General information

NPI: 1285870022
Provider Name (Legal Business Name): RONALD C ADAIR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST 7TH AVE
FORT YUKON AK
99740-0309
US

IV. Provider business mailing address

PO BOX 309
FORT YUKON AK
99740-0309
US

V. Phone/Fax

Practice location:
  • Phone: 907-662-2460
  • Fax: 907-662-2709
Mailing address:
  • Phone: 907-662-2460
  • Fax: 907-662-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1269
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: