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General NPI Number Information
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NPI Number | 1093213167
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Entity Type | Organization
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Legal Business Name | KODIAK AREA NATIVE ASSOCIATION
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 1317 MILL BAY RD
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City | KODIAK
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State | AK
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Zip | 99615-6411
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Country | US
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Telephone | 907-486-3291
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Fax | 907-486-9896
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Provider Business Mailing Address
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Address Line | 3449 E REZANOF DR
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City | KODIAK
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State | AK
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Zip | 99615-6952
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Country | US
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Telephone | 907-486-9880
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Fax | 907-486-9896
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MICHAEL PFEFFER
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Credential |
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Telephone | 907-486-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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