Healthcare Provider Details

I. General information

NPI: 1003281866
Provider Name (Legal Business Name): SABRINA MARIE BEIERLY VICK DHAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SABRINA MARIE BEIERLY CHILTON

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 HOSPITAL DR
JUNEAU AK
99801-7809
US

IV. Provider business mailing address

3100 CHANNEL DR STE 300
JUNEAU AK
99801-7837
US

V. Phone/Fax

Practice location:
  • Phone: 907-463-4040
  • Fax:
Mailing address:
  • Phone: 907-463-4074
  • Fax: 907-463-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number15-131-DHAT
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: