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General NPI Number Information
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NPI Number | 1114713625
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Entity Type | Organization
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Legal Business Name | ERIC NANCE AK
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Dates
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Enumeration Date | 04/19/2025
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Last Update Date | 04/19/2025
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Provider Practice Location Address
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Address Line | 130 CARLANNA LAKE RD
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City | KETCHIKAN
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State | AK
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Zip | 99901-5669
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Country | US
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Telephone | 801-369-0012
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Fax |
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Provider Business Mailing Address
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Address Line | 1923 E 475 S
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City | SPRINGVILLE
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State | UT
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Zip | 84663-2634
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Country | US
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Telephone | 801-369-0012
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC DAVID NANCE
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Credential | DMD
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Telephone | 801-369-0012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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