Healthcare Provider Details

I. General information

NPI: 1053695247
Provider Name (Legal Business Name): SEARHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 KLAWOCK/HOLLIS HWY
KLAWOCK AK
99925-0069
US

IV. Provider business mailing address

PO BOX 69
KLAWOCK AK
99925-0069
US

V. Phone/Fax

Practice location:
  • Phone: 907-755-4918
  • Fax: 907-755-4811
Mailing address:
  • Phone: 907-755-4918
  • Fax: 907-755-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number11-075-PDHA I
License Number StateAK

VIII. Authorized Official

Name: KRISTINA SAFFORD
Title or Position: DENTAL HEALTH AIDE
Credential:
Phone: 907-755-4918