Organization · Type 2 NPI

Southcentral Foundation

General Practice Dentistry · Pedro Bay, AK

NPI number 1144777046 Active

Practice location

2516 Mountain Circle
Pedro Bay, AK 99647

Call (907) 850-2229 Map

Mailing address

PO Box 35151
Seattle, WA 98124-5151

Specialties and licenses

Taxonomy	Code	License
General Practice Dentistry Primary	1223G0001X	20467 (AK)

General Practice Dentistry: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

3 other providers at this address

NPI record

NPI: 1144777046
Entity type: Organization (Type 2)
Issued: Sep 8, 2016
Last updated: Sep 1, 2023
Status: Active
Subpart: Yes of Southcentral Foundation

Other names

<unavail>
Dental- Pedro Bay Dental Clinic · doing business as
Dental- Pedro Bay Dental Clinic · doing business as

Authorized official

Ronald Lee Olson
Executive Vice President Finance
(907) 729-4939

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1144777046

Southcentral Foundation's National Provider Identifier is 1144777046, issued on Sep 8, 2016. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in Pedro Bay, AK. The record was last updated on Sep 1, 2023.