Healthcare Provider Details

I. General information

NPI: 1174695803
Provider Name (Legal Business Name): ERIC P BUETOW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 HORSESHOE WAY
NORTH POLE AK
99705
US

IV. Provider business mailing address

PO BOX 56258 2933 HORSESHOE WAY
NORTH POLE AK
99705
US

V. Phone/Fax

Practice location:
  • Phone: 907-488-0861
  • Fax: 907-488-3141
Mailing address:
  • Phone: 907-488-0861
  • Fax: 907-488-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number523
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: