MEDICARE: DENALI FAMILY DENTAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1053	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1841128	OTHER	AK	TRICARE

General Provider Information

NPI Number	:	1447381421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENALI FAMILY DENTAL CENTER

Provider Business Mailing Address
First Line	:	3401 DENALI ST
Second Line	:	SUITE 102
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-4034
Country	:	US
Telephone Number	:	907-561-1317
Fax Number	:	907-561-4695

Provider Business Practice Location Address
First Line	:	3401 DENALI ST
Second Line	:	SUITE 102
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-4034
Country	:	US
Telephone Number	:	907-561-1317
Fax Number	:	907-561-4695

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID L. MAISEY
Credential	:	DDS
Telephone Number	:	907-561-1317

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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Directions to “DENALI FAMILY DENTAL CENTER ” Practice Location

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