Healthcare Provider Details

I. General information

NPI: 1609283621
Provider Name (Legal Business Name): LAUREN TOOYAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 5TH TED STEVENS WAY
KOTZEBUE AK
99752-0043
US

IV. Provider business mailing address

PO BOX 43 436 5TH TED STEVENS WAY
KOTZEBUE AK
99752-0043
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-7325
  • Fax:
Mailing address:
  • Phone: 907-442-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number6923706
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: