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General NPI Number Information
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NPI Number | 1306273446
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Entity Type | Organization
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Legal Business Name | 'GENTLE DENTISTRY' JENNIFER SPIVEY DDS
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 204 REZANOF DR E SUITE #201
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City | KODIAK
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State | AK
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Zip | 99615-6379
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Country | US
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Telephone | 907-481-3567
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Fax | 907-481-3564
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Provider Business Mailing Address
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Address Line | 204 EAST REZANOF DR. STE. # 201
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City | KODIAK
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State | AK
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Zip | 99615
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Country | US
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Telephone | 907-481-3567
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Fax | 907-481-3564
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SINIA LOKELANI MAILE
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Credential |
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Telephone | 907-481-3567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9221
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License Number State | AK
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