Southcentral Foundation
Dentist, General Practice in Wasilla, AK. Organization (NPI-2).
NPI number1124603733
StatusActive
Last updated in NPPESJun 5, 2026
Details
- NPI
- 1124603733
- Entity type
- Organization (NPI-2)
- Legal business name
- Southcentral Foundation
- Organization subpart
- Yes
- Enumeration date
- Mar 15, 2021
- Certification date
- Jun 5, 2026
- Last updated
- Jun 5, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | |
| 261QM2500X | Clinic/Center, Medical Specialty | – | – |
Other names
- Benteh Nuutah Dental Clinic (Doing Business As)
Practice location
1001 S Knik Goose Bay RdWasilla, AK 99654-8083
Phone 907-631-7690
Mailing address
Po Box 35151Seattle, WA 98124-5151
Authorized official
Ronald Lee Olson
Executive Vice President Finance
9077294939
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