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General NPI Number Information
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NPI Number | 1831621093
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Entity Type | Organization
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Legal Business Name | AOFS VAN LEEUWEN PC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 1275 SADLER WAY STE 202
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City | FAIRBANKS
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State | AK
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Zip | 99701-3175
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Country | US
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Telephone | 907-452-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 SADLER WAY STE 202
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City | FAIRBANKS
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State | AK
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Zip | 99701-3175
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Country | US
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Telephone | 907-452-4101
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. BILLIE JO MARTIN
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Credential |
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Telephone | 907-452-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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