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General NPI Number Information
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NPI Number | 1154672558
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Entity Type | Organization
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Legal Business Name | MABRY AND MABRY DENTISTRY, LLC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 2601 BONIFACE PKWY STE 1
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City | ANCHORAGE
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State | AK
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Zip | 99504-3144
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Country | US
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Telephone | 907-337-9448
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Fax | 907-337-4123
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Provider Business Mailing Address
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Address Line | 2601 BONIFACE PKWY STE 1
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City | ANCHORAGE
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State | AK
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Zip | 99504-3144
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Country | US
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Telephone | 907-337-9448
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Fax | 907-337-4123
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Authorized Official
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Title or Position | OWNER
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Name | LARA M. MABRY
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Credential | DDS
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Telephone | 907-337-9448
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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 | 377
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1200
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License Number State | AK
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